Provider Demographics
NPI:1093431074
Name:MOTHER GOOSE HEALTH
Entity Type:Organization
Organization Name:MOTHER GOOSE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-566-6543
Mailing Address - Street 1:90 MAIDEN LN
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4831
Mailing Address - Country:US
Mailing Address - Phone:917-566-6543
Mailing Address - Fax:
Practice Address - Street 1:90 MAIDEN LN
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4831
Practice Address - Country:US
Practice Address - Phone:917-566-6543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management