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General NPI Number Information
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NPI Number | 1922033836
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Entity Type | Organization
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Legal Business Name | BOULEVARD SURGICAL CENTER, INC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 46-04 31ST AVENUE
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City | LONG ISLAND CITY
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State | NY
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Zip | 11103-1842
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Country | US
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Telephone | 718-545-5050
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Fax | 718-545-5052
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Provider Business Mailing Address
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Address Line | 46-04 31ST AVENUE
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City | LONG ISLAND CITY
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State | NY
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Zip | 11103-1842
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Country | US
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Telephone | 718-545-5050
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Fax | 718-545-5052
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DROR ROSENFELD
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Credential | MD
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Telephone | 718-545-5050
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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 | 700326OR
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License Number State | NY
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