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General NPI Number Information
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NPI Number | 1700329166
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Entity Type | Organization
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Legal Business Name | JUST FOR KICKS SWIMMING
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Dates
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Enumeration Date | 12/02/2016
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 411 E 10TH ST
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City | NEW YORK
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State | NY
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Zip | 10009-4227
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Country | US
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Telephone | 914-522-8849
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Fax |
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Provider Business Mailing Address
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Address Line | 411 E 10TH ST
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City | NEW YORK
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State | NY
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Zip | 10009-4227
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. KYLE HACKSHAW
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Credential |
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Telephone | 914-522-8849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State | NY
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