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General NPI Number Information
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NPI Number | 1780116616
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Entity Type | Organization
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Legal Business Name | KIDSABILITATION INC.
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 8047 268TH ST
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City | FLORAL PARK
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State | NY
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Zip | 11004-1543
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Country | US
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Telephone | 516-263-0418
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Fax |
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Provider Business Mailing Address
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Address Line | 8047 268TH ST
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City | FLORAL PARK
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State | NY
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Zip | 11004-1543
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Country | US
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Telephone | 516-263-0418
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARISSA V VICTORIO
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Credential | PT
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Telephone | 516-395-3992
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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 | PT024147
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License Number State | NY
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