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General NPI Number Information
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NPI Number | 1558612762
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Entity Type | Organization
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Legal Business Name | QUEENS BOULEVARD ASC LLC
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Dates
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Enumeration Date | 09/27/2012
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 9525 QUEENS BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-4510
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Country | US
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Telephone | 718-406-8000
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Fax | 929-214-4425
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Provider Business Mailing Address
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Address Line | 95-25 QUEENS BOULEVARD
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City | REGO PARK
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State | NY
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Zip | 11374-0000
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Country | US
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Telephone | 718-406-8000
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Fax | 929-214-4425
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Authorized Official
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Title or Position | OWNER
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Name | AZEEM KHAN
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Credential | MD
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Telephone | 718-406-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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