NPIMap

Organization Active NPI

Kidology, Inc.

  • Early Intervention Provider Agency
  • Southampton, PA
National Provider Identifier
1023424231
Registry record updated Nov 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
184704659 Issued in PA
Legal business name
KIDOLOGY, INC.
Practice address
928 Jaymor Rd Ste C-150
Southampton, PA 18966-3832
Phone
(215) 330-4116
NPI assigned
Jul 8, 2014
Last updated
Nov 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Luba PatlakhNPI 1861986978
Title
President
Phone
(267) 968-1707

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Occupational Therapist 225X00000X
Speech-Language Pathologist 235Z00000X
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Early Intervention Provider Agency 252Y00000X 184704659 PA Primary

Addresses

Primary practice location

928 Jaymor Rd Ste C-150
Southampton, PA 18966-3832

Mailing address

928 Jaymor Rd Ste C-150
Southampton, PA 18966-3832
Phone (215) 330-4116

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190625001188 PA Part B Supplier - Clinic/Group Practice 8527392588 Receives reassigned benefits from 1 practitioner
Practice locations: Southampton, PA

National Provider Directory

National Provider Directory

Locations

2810 Southampton Rd
Philadelphia, PA 19154
Phone (215) 330-4116

928 Jaymor Rd
Ste C150
Southampton, PA 18966
Phone (215) 330-4116

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667520000000",
    "number": "1023424231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "928 JAYMOR RD STE C-150",
            "city": "SOUTHAMPTON",
            "state": "PA",
            "postal_code": "189663832",
            "telephone_number": "215-330-4116",
            "fax_number": "215-330-4118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 JAYMOR RD STE C-150",
            "city": "SOUTHAMPTON",
            "state": "PA",
            "postal_code": "189663832",
            "telephone_number": "215-330-4116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-08",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A",
        "authorized_official_last_name": "PATLAKH",
        "authorized_official_first_name": "LUBA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "267-968-1707"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "PA",
            "license": "184704659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southampton, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.