Healthcare Provider Details

I. General information

NPI: 1063757607
Provider Name (Legal Business Name): EAST NY ADULT DAYCARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2012
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89-31 161 STREET 2ND FLOOR
JAMAICA NY
11432
US

IV. Provider business mailing address

89-31 161 STREET 2ND FLOOR
JAMAICA NY
11432
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-2254
  • Fax: 718-206-2253
Mailing address:
  • Phone: 718-206-2254
  • Fax: 718-206-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ZAKHAR PEYSAKHOV
Title or Position: CEO
Credential:
Phone: 347-770-8993