Provider Demographics
NPI:1912872805
Name:KINGS BAY YM-YWHA
Entity type:Organization
Organization Name:KINGS BAY YM-YWHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PETLAKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-648-7703
Mailing Address - Street 1:9502 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5432
Mailing Address - Country:US
Mailing Address - Phone:718-648-7703
Mailing Address - Fax:718-889-0679
Practice Address - Street 1:9502 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5432
Practice Address - Country:US
Practice Address - Phone:718-648-7703
Practice Address - Fax:718-889-0679
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGS BAY YM-YWHA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care