Healthcare Provider Details

I. General information

NPI: 1861303091
Provider Name (Legal Business Name): OUR PATCHWORK KIDZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CRISFIELD ST APT 1Q
YONKERS NY
10710-1242
US

IV. Provider business mailing address

66 CRISFIELD ST APT 1Q
YONKERS NY
10710-1242
US

V. Phone/Fax

Practice location:
  • Phone: 845-300-0693
  • Fax:
Mailing address:
  • Phone: 845-300-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: LADYBIRD MANANGAN REYES
Title or Position: DIRECTOR/OWNER
Credential: PT
Phone: 845-300-0693