Provider Demographics
NPI:1457616955
Name:THE PERFECT PLAYGROUND
Entity Type:Organization
Organization Name:THE PERFECT PLAYGROUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CABAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-619-7137
Mailing Address - Street 1:765 DAVIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310
Mailing Address - Country:US
Mailing Address - Phone:718-727-9816
Mailing Address - Fax:
Practice Address - Street 1:3391 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2025
Practice Address - Country:US
Practice Address - Phone:718-608-9170
Practice Address - Fax:718-608-9179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY671498876251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services