Organization
QUEENS BOULEVARD EXTENDED CARE FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN J COHEN (FINANCE DIRECTOR)
(718) 205-0287
Entity
Organization
Contact information
Practice address
6111 QUEENS BLVD, WOODSIDE, NY 11377-4965
(718) 205-0287
(718) 205-1342
Mailing address
6111 QUEENS BLVD, WOODSIDE, NY 11377-4965
(718) 205-0287
(718) 205-1342
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
7003390N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01626686
—
NY
05
—
01710672
—
NY
05
—
7003390N
—
NY
Enumeration date
08/26/2005
Last updated
08/22/2020
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