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General NPI Number Information
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NPI Number | 1265819684
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Entity Type | Organization
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Legal Business Name | KIP ENTERPRISE, INC.
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 306 W 114TH ST #1B
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City | NEW YORK
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State | NY
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Zip | 10026-2736
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Country | US
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Telephone | 917-724-6257
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Fax |
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Provider Business Mailing Address
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Address Line | 306 W 114TH ST #1B
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City | NEW YORK
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State | NY
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Zip | 10026-2736
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Country | US
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Telephone | 917-724-6257
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MS. KESCIA I PRIOLEAU
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Credential | MSED
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Telephone | 917-724-6257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 4571417
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License Number State | NY
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