Organization
QUEENS BLVD EXT CARE FACILITY MANAGEMENT LLC
Active
Other names
Queens Blvd Ext Care
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH MALONE (CFO)
(718) 205-0298
Entity
Organization
Contact information
Practice address
6111 QUEENS BLVD, WOODSIDE, NY 11377-4965
(718) 205-0298
Mailing address
6111 QUEENS BLVD, WOODSIDE, NY 11377-4965
(718) 205-0298
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
703410N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2996110
—
NY
Enumeration date
09/04/2014
Last updated
09/04/2014
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