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General NPI Number Information
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NPI Number | 1649310996
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Entity Type | Organization
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Legal Business Name | KIDZ KARE OF GREAT NECK LLP
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 107 NORTHERN BLVD SUITE 201
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City | GREAT NECK
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State | NY
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Zip | 11021-4309
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Country | US
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Telephone | 516-487-6565
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Fax | 516-487-3057
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Provider Business Mailing Address
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Address Line | 107 NORTHERN BLVD SUITE 201
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City | GREAT NECK
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State | NY
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Zip | 11021-4309
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Country | US
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Telephone | 516-487-6565
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Fax | 516-487-3057
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MS. MERCEDES IOCCO
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Credential |
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Telephone | 516-487-6565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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