MEDICARE: WONDIRFUL PLAY IL PLLC

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1063376671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WONDIRFUL PLAY IL PLLC

Provider Business Mailing Address
First Line	:	83 MERON RD
Second Line	:
City	:	MONSEY
State	:	NY
Zip	:	10952-2215
Country	:	US
Telephone Number	:	732-353-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 CHATHAM RD STE R
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4188
Country	:	US
Telephone Number	:	732-353-1414
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBERS
Name	:	HERSHEL FRIEDMAN
Credential	:
Telephone Number	:	732-353-1414

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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