Provider Demographics
NPI:1093264434
Name:KIDWORKS
Entity Type:Organization
Organization Name:KIDWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEACHER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS SPECIAL ED
Authorized Official - Phone:631-580-2738
Mailing Address - Street 1:95 CLARENDON RD
Mailing Address - Street 2:
Mailing Address - City:LK RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-1649
Mailing Address - Country:US
Mailing Address - Phone:631-580-2738
Mailing Address - Fax:
Practice Address - Street 1:125 E BETHPAGE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4228
Practice Address - Country:US
Practice Address - Phone:516-731-5588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY662936061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty