Provider Demographics
NPI:1023424231
Name:KIDOLOGY, INC.
Entity type:Organization
Organization Name:KIDOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUBA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATLAKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-968-1707
Mailing Address - Street 1:928 JAYMOR RD STE C-150
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3832
Mailing Address - Country:US
Mailing Address - Phone:215-330-4116
Mailing Address - Fax:215-330-4118
Practice Address - Street 1:928 JAYMOR RD STE C-150
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3832
Practice Address - Country:US
Practice Address - Phone:215-330-4116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 235Z00000X, 261QM0855X
PA184704659252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health