Provider Demographics
NPI:1649310996
Name:KIDZ KARE OF GREAT NECK LLP
Entity type:Organization
Organization Name:KIDZ KARE OF GREAT NECK LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:IOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-487-6565
Mailing Address - Street 1:107 NORTHERN BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4309
Mailing Address - Country:US
Mailing Address - Phone:516-487-6565
Mailing Address - Fax:516-487-3057
Practice Address - Street 1:107 NORTHERN BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4309
Practice Address - Country:US
Practice Address - Phone:516-487-6565
Practice Address - Fax:516-487-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty