Healthcare Provider Details

I. General information

NPI: 1639532989
Provider Name (Legal Business Name): REGO PARK SENIORS CLUB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6336 99TH ST
REGO PARK NY
11374-1979
US

IV. Provider business mailing address

6336 99TH ST
REGO PARK NY
11374-1979
US

V. Phone/Fax

Practice location:
  • Phone: 718-459-2444
  • Fax:
Mailing address:
  • Phone: 718-459-2444
  • Fax:

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: EMANUIL KALENDAREV
Title or Position: MANAGING MEMBER
Credential:
Phone: 718-496-3834