Provider Demographics
NPI:1205364437
Name:THE KIDZ LOUNGE RELATED SERVICES LLC
Entity type:Organization
Organization Name:THE KIDZ LOUNGE RELATED SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEO
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:718-848-0875
Mailing Address - Street 1:15801 CROSSBAY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3140
Mailing Address - Country:US
Mailing Address - Phone:718-848-0875
Mailing Address - Fax:718-848-0876
Practice Address - Street 1:15801 CROSSBAY BLVD
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3140
Practice Address - Country:US
Practice Address - Phone:718-848-0875
Practice Address - Fax:718-848-0876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025077-1225100000X
NY020061-1235Z00000X
251B00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1033422076Medicaid
NY1639314578Medicaid