Provider Demographics
NPI:1225495229
Name:DYNAMIC KIDS
Entity Type:Organization
Organization Name:DYNAMIC KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:914-428-5151
Mailing Address - Street 1:6 CRESTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-5106
Mailing Address - Country:US
Mailing Address - Phone:914-588-0107
Mailing Address - Fax:
Practice Address - Street 1:210 N CENTRAL AVE # 340A
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1911
Practice Address - Country:US
Practice Address - Phone:914-428-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP00502252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency