Provider Demographics
NPI:1750638474
Name:KIDSPLORATION
Entity Type:Organization
Organization Name:KIDSPLORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEACHER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS SP ED
Authorized Official - Phone:718-251-3924
Mailing Address - Street 1:1086 BERGEN AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5377
Mailing Address - Country:US
Mailing Address - Phone:718-251-3924
Mailing Address - Fax:
Practice Address - Street 1:1086 BERGEN AVE APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5377
Practice Address - Country:US
Practice Address - Phone:718-251-3924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24451252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency