Provider Demographics
NPI:1265562979
Name:EAST END KIDS THERAPY, INC.
Entity type:Organization
Organization Name:EAST END KIDS THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SICILIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCHOLOGIST
Authorized Official - Phone:631-267-2900
Mailing Address - Street 1:502 N SEA RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-2012
Mailing Address - Country:US
Mailing Address - Phone:631-267-2900
Mailing Address - Fax:631-267-2950
Practice Address - Street 1:502 N SEA RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-2012
Practice Address - Country:US
Practice Address - Phone:631-267-2900
Practice Address - Fax:631-267-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health