Provider Demographics
NPI:1568688349
Name:GREAT NECK ENTERPRISES INC
Entity Type:Organization
Organization Name:GREAT NECK ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LISKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-810-3483
Mailing Address - Street 1:1415 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-1555
Mailing Address - Country:US
Mailing Address - Phone:954-810-3483
Mailing Address - Fax:954-757-6242
Practice Address - Street 1:1415 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-1555
Practice Address - Country:US
Practice Address - Phone:954-810-3483
Practice Address - Fax:954-757-6242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL370332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0553970001Medicare ID - Type Unspecified