Provider Demographics
NPI:1598187304
Name:PRIME KIDS
Entity Type:Organization
Organization Name:PRIME KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOFIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFAILOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-880-1204
Mailing Address - Street 1:15044 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3437
Mailing Address - Country:US
Mailing Address - Phone:718-880-1204
Mailing Address - Fax:718-880-1204
Practice Address - Street 1:15044 78TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3437
Practice Address - Country:US
Practice Address - Phone:718-880-1204
Practice Address - Fax:718-880-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency