Just Kids

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

475564 Issued in NY

Legal business name

JUST KIDS

Practice address

2111 Avalon Pines Dr
Coram, NY 11727-5146

Phone

(631) 708-8403

NPI assigned

Jun 20, 2013

Last updated

Jun 20, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Penney R Obrien, REGISTERED NURSE

Title

Registered Nurse

Phone

(631) 708-8403

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1371686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371686400000",
    "number": "1548609803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 AVALON PINES DR",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117275146",
            "telephone_number": "631-708-8403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 AVALON PINES DR",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117275146",
            "telephone_number": "631-708-8403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUST KIDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-20",
        "last_updated": "2013-06-20",
        "status": "A",
        "authorized_official_last_name": "OBRIEN",
        "authorized_official_first_name": "PENNEY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "REGISTERED NURSE",
        "authorized_official_telephone_number": "631-708-8403",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "REGISTERED NURSE"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NY",
            "license": "475564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keisha Joseph-Brister
• Eckner B Joseph, LPN
• Zena Esther Sara Joseph, M.D.
• Kriston Josephs, LPN
• Julie Modavis LCSW PLLC
• Jennifer Kane
• Lili Kanyoosky, RN
• Richard Constantine Kardovich, D.D.S.
• Ildegonde Karererwa
• Veronica Karris

• Intellectual Disabilities Intermediate Care Facility in Coram, NY
• Providers in Coram, NY by specialty
• Intellectual Disabilities Intermediate Care Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.