Provider Demographics
NPI:1053564799
Name:CENTRAL QUEENS DAY SURGICAL CENTER, INC.
Entity type:Organization
Organization Name:CENTRAL QUEENS DAY SURGICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-849-8700
Mailing Address - Street 1:8340 WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7824
Mailing Address - Country:US
Mailing Address - Phone:718-849-8700
Mailing Address - Fax:718-849-6523
Practice Address - Street 1:8340 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7824
Practice Address - Country:US
Practice Address - Phone:718-849-8700
Practice Address - Fax:718-849-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003242R261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01373564Medicaid
NY00707AMedicare PIN