MEDICARE: WONDER KIDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency	013791-1	NY

General Provider Information

NPI Number	:	1053627489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WONDER KIDS

Provider Business Mailing Address
First Line	:	21 MERCEDES LN
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-2605
Country	:	US
Telephone Number	:	203-569-6697
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 MERCEDES LN
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-2605
Country	:	US
Telephone Number	:	203-569-6697
Fax Number	:

Authorized Official
Title or Position	:	OTR/L
Name	:	RALPH SCHRADER
Credential	:
Telephone Number	:	914-421-8270

Provider Enumeration Date	:	08/23/2010
Last Update Date	:	08/23/2010

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Directions to “WONDER KIDS ” Practice Location

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