MEDICARE: COLON AND RECTAL SURGERY OF QUEENS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician

General Provider Information

NPI Number	:	1164217006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLON AND RECTAL SURGERY OF QUEENS PLLC

Provider Business Mailing Address
First Line	:	6344 SAUNDERS ST
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-2039
Country	:	US
Telephone Number	:	718-475-2017
Fax Number	:	718-475-2046

Provider Business Practice Location Address
First Line	:	6344 SAUNDERS ST
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-2039
Country	:	US
Telephone Number	:	347-239-8882
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER / PHYSICIAN
Name	:	ARTHUR YUSHUVA
Credential	:	MD
Telephone Number	:	718-475-2017

Provider Enumeration Date	:	04/11/2025
Last Update Date	:	12/19/2025

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