Provider Demographics
NPI:1588065817
Name:KID CLAN SERVICES IN
Entity type:Organization
Organization Name:KID CLAN SERVICES IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEITER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:973-365-1444
Mailing Address - Street 1:340 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1328
Mailing Address - Country:US
Mailing Address - Phone:973-365-1444
Mailing Address - Fax:973-365-1446
Practice Address - Street 1:340 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1328
Practice Address - Country:US
Practice Address - Phone:973-365-1444
Practice Address - Fax:973-365-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty