Provider Demographics
NPI:1477802106
Name:WISEKIDZ LEARNING SOLUTIONS OF NEW YORK, LLC
Entity Type:Organization
Organization Name:WISEKIDZ LEARNING SOLUTIONS OF NEW YORK, LLC
Other - Org Name:WISEKIDZ SOLUTIONS OF NEW YORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENYANA
Authorized Official - Middle Name:N
Authorized Official - Last Name:GAY-WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-381-6335
Mailing Address - Street 1:PO BOX 5213
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30154-0004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 PARK AVE
Practice Address - Street 2:16TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5516
Practice Address - Country:US
Practice Address - Phone:845-381-6335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WISEKIDZ LEARNING SOLUTIONS OF GEORGIA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty