Provider Demographics
NPI:1003246414
Name:DYNAMIC PEDIATRIC SERVICES LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:DYNAMIC PEDIATRIC SERVICES LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEHILA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LAUFER
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MS
Authorized Official - Phone:323-434-8222
Mailing Address - Street 1:31 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2800
Mailing Address - Country:US
Mailing Address - Phone:323-434-8222
Mailing Address - Fax:
Practice Address - Street 1:31 8TH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2800
Practice Address - Country:US
Practice Address - Phone:323-434-8222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty