MEDICARE: FCN SURGERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1023953858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FCN SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	718 BROUGHTON ST
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29115-6648
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6406 FLEET ST
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-5243
Country	:	US
Telephone Number	:	718-896-3080
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KEVIN RAY
Credential	:	DPM
Telephone Number	:	917-405-7881

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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Directions to “FCN SURGERY CENTER, LLC ” Practice Location

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