Queens Boulevard Extended Care Facility Dialysis Center LLC

NPI #1619539996 in Woodside, New York

Provider Information

NPI Number: 1619539996
Entity Type: Organization
Organization Name: Queens Boulevard Extended Care Facility Dialysis Center LLC
Primary Specialty: Clinic/Center - End-Stage Renal Disease (ESRD) Treatment
Enumeration Date: Jul 8, 2019
Last Updated: Dec 15, 2021

Practice Location

Address: 6111 QUEENS BLVD
City: Woodside
State: New York
ZIP Code: 11377-4965
Phone: (718) 205-0287

Authorized Official

Name: JAMES CLEMENZA
Title: MANAGING MEMBER
Phone: (718) 205-0287

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment — End-Stage Renal Disease (ESRD) Treatment	261QE0700X	Primary

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