Provider Demographics
NPI:1083981922
Name:GAYLE E. KLIGMAN THERAPEUTIC RESOURCES
Entity Type:Organization
Organization Name:GAYLE E. KLIGMAN THERAPEUTIC RESOURCES
Other - Org Name:KIDZ THERAPY SERVICES, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KLIGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC SDL
Authorized Official - Phone:516-747-9030
Mailing Address - Street 1:300 GARDEN CITY PLZ
Mailing Address - Street 2:SUITE 350
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3302
Mailing Address - Country:US
Mailing Address - Phone:516-747-9030
Mailing Address - Fax:516-877-0998
Practice Address - Street 1:300 GARDEN CITY PLZ
Practice Address - Street 2:SUITE 350
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3302
Practice Address - Country:US
Practice Address - Phone:516-747-9030
Practice Address - Fax:516-877-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001714-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency