Healthcare Provider Details

I. General information

NPI: 1770039349
Provider Name (Legal Business Name): ASIAN ADULT DAY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 QUEENS BOULEVARD
SUNNYSIDE NY
11104
US

IV. Provider business mailing address

4120 QUEENS BLVD
SUNNYSIDE NY
11104-2802
US

V. Phone/Fax

Practice location:
  • Phone: 718-786-8396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PRABIR MITRA
Title or Position: OFFICER
Credential:
Phone: 718-786-8396