Healthcare Provider Details

I. General information

NPI: 1639995822
Provider Name (Legal Business Name): KIDS CONNECT USA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 FOREST AVE
STATEN ISLAND NY
10310-2520
US

IV. Provider business mailing address

24 JESSICA LN
STATEN ISLAND NY
10309-1968
US

V. Phone/Fax

Practice location:
  • Phone: 718-702-3340
  • Fax:
Mailing address:
  • Phone: 718-702-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: PIERA SANTANGELO
Title or Position: OWNER
Credential:
Phone: 718-702-3340