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General NPI Number Information
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NPI Number | 1851717383
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Entity Type | Organization
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Legal Business Name | NYEEQASC,LLC
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Dates
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Enumeration Date | 03/07/2014
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 4564 FRANCIS LEWIS BLVD SUITE 200
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City | BAYSIDE
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State | NY
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Zip | 11361
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Country | US
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Telephone | 929-258-7720
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Fax | 929-258-7722
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Provider Business Mailing Address
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Address Line | 4564 FRANCIS LEWIS BLVD SUITE 200
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City | BAYSIDE
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State | NY
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Zip | 11361
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Country | US
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Telephone | 929-258-7720
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Fax | 929-258-7722
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Authorized Official
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Title or Position | V.P. OF OPERATIONS
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Name | DEBORAH COMERFORD
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Credential | RN
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Telephone | 781-812-4665
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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 | 9784
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License Number State | NY
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