Provider Demographics
NPI:1063979037
Name:KIDZ IN MOTION SERVICES, PA
Entity type:Organization
Organization Name:KIDZ IN MOTION SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSHEYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-562-6702
Mailing Address - Street 1:2610 NE 213TH ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1139
Mailing Address - Country:US
Mailing Address - Phone:917-562-6702
Mailing Address - Fax:917-554-6065
Practice Address - Street 1:2610 NE 213TH ST UNIT 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1139
Practice Address - Country:US
Practice Address - Phone:917-562-6702
Practice Address - Fax:917-554-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center