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General NPI Number Information
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NPI Number | 1083220123
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Entity Type | Organization
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Legal Business Name | QUEENS SURGICAL CENTER LLC
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 3636 MAIN ST STE 1S
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City | FLUSHING
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State | NY
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Zip | 11354-6517
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Country | US
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Telephone | 347-592-1120
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Fax | 800-550-4779
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Provider Business Mailing Address
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Address Line | 3636 MAIN ST STE 1S
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City | FLUSHING
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State | NY
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Zip | 11354-6517
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Country | US
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Telephone | 347-592-1120
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Fax | 800-550-4779
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. BRIAN S PUN
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Credential |
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Telephone | 347-592-1120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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