Organization
QUEENS BOULEVARD EXTENDED CARE FACILITY DIALYSIS CENTER LLC
Active
Other names
QUEENS BOULEVARD EXTENDED CARE DIALYSIS CENTER LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES CLEMENZA (MANAGING MEMBER)
(718) 205-0287
Entity
Organization
Contact information
Practice address
6111 QUEENS BLVD, WOODSIDE, NY 11377-4965
(718) 205-0287
Mailing address
6111 QUEENS BLVD, WOODSIDE, NY 11377-4965
(718) 205-0287
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
07/08/2019
Last updated
12/15/2021
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