Provider Demographics
NPI:1629236823
Name:KIDZ XPRESS
Entity Type:Organization
Organization Name:KIDZ XPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEAD
Authorized Official - Suffix:
Authorized Official - Credentials:PNP
Authorized Official - Phone:716-625-4343
Mailing Address - Street 1:PO BOX 4098
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-8098
Mailing Address - Country:US
Mailing Address - Phone:716-693-6365
Mailing Address - Fax:716-693-6939
Practice Address - Street 1:3571 NIAGARA FALLS BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1200
Practice Address - Country:US
Practice Address - Phone:716-693-6365
Practice Address - Fax:716-693-6939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-381393261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care