Healthcare Provider Details

I. General information

NPI: 1023953858
Provider Name (Legal Business Name): FCN SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6406 FLEET ST
REGO PARK NY
11374-5243
US

IV. Provider business mailing address

718 BROUGHTON ST
ORANGEBURG SC
29115-6648
US

V. Phone/Fax

Practice location:
  • Phone: 718-896-3080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN RAY
Title or Position: CEO
Credential: DPM
Phone: 917-405-7881