Healthcare Provider Details

I. General information

NPI: 1164217006
Provider Name (Legal Business Name): COLON AND RECTAL SURGERY OF QUEENS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6344 SAUNDERS ST
REGO PARK NY
11374-2039
US

IV. Provider business mailing address

6344 SAUNDERS ST
REGO PARK NY
11374-2039
US

V. Phone/Fax

Practice location:
  • Phone: 347-239-8882
  • Fax:
Mailing address:
  • Phone: 718-475-2017
  • Fax: 718-475-2046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ARTHUR YUSHUVA
Title or Position: MANAGING MEMBER / PHYSICIAN
Credential: MD
Phone: 718-475-2017