Provider Demographics
NPI:1952951634
Name:SAMUEL'S KIDS
Entity type:Organization
Organization Name:SAMUEL'S KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:347-255-1899
Mailing Address - Street 1:3235 EMMONS AVE APT 716
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1157
Mailing Address - Country:US
Mailing Address - Phone:347-255-1899
Mailing Address - Fax:
Practice Address - Street 1:3235 EMMONS AVE APT 716
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1157
Practice Address - Country:US
Practice Address - Phone:347-255-1899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency