Healthcare Provider Details

I. General information

NPI: 1174713671
Provider Name (Legal Business Name): QUEENS RESPIRATORY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7684 STATE ROUTE 417
ADDISON NY
14801-9507
US

IV. Provider business mailing address

9825 64TH RD APT. 7D
REGO PARK NY
11374-3452
US

V. Phone/Fax

Practice location:
  • Phone: 607-359-2807
  • Fax:
Mailing address:
  • Phone: 718-896-4542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0867120001
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerPROVIDER NUMBER

VIII. Authorized Official

Name: ENRIQUE R RAVARRA
Title or Position: RESPIRATORY TECHNICIAN
Credential:
Phone: 718-896-4542