=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508653593
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MNK KIDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2025
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 574 DONALD LN
-----------------------------------------------------
City | WOODMERE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11598-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-937-8844
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 574 DONALD LN
-----------------------------------------------------
City | WOODMERE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11598-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-937-8844
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. YAFIT GADAEV
-----------------------------------------------------
Credential | MSPED
-----------------------------------------------------
Telephone | 917-937-8844
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------