Healthcare Provider Details

I. General information

NPI: 1780935528
Provider Name (Legal Business Name): QUEENS ENDOSCOPY ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17660 UNION TPKE
FRESH MEADOWS NY
11366-1526
US

IV. Provider business mailing address

2500 YORK RD STE 300
JAMISON PA
18929-1098
US

V. Phone/Fax

Practice location:
  • Phone: 718-425-3300
  • Fax: 718-820-0610
Mailing address:
  • Phone: 215-589-9024
  • Fax: 833-705-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: LESLIE HERNANDEZ
Title or Position: CEO
Credential:
Phone: 718-425-3300