Organization
CLUB 55 PRESTIGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYDIA MUSHEYEV (OWNER-DIRECTOR)
(718) 812-8112
Entity
Organization
Contact information
Practice address
6408 FLEET ST, REGO PARK, NY 11374-5244
(718) 275-5275
(718) 275-2652
Mailing address
9707 63RD RD APT 3N, REGO PARK, NY 11374-1610
(718) 275-5275
(718) 275-2652
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
—
—
Other
Enumeration date
02/24/2017
Last updated
02/24/2017
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