Provider Demographics
NPI:1003357815
Name:KEW GARDENS SEP INC.
Entity Type:Organization
Organization Name:KEW GARDENS SEP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKUBOV
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:718-263-5437
Mailing Address - Street 1:159-16 UNION TPKE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-263-5437
Mailing Address - Fax:718-263-5444
Practice Address - Street 1:15916 UNION TPKE
Practice Address - Street 2:SUITE 308
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1954
Practice Address - Country:US
Practice Address - Phone:718-263-5437
Practice Address - Fax:718-263-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health