Provider Demographics
NPI:1003809245
Name:SOUTH QUEENS NEPHROLOGY ASSO
Entity Type:Organization
Organization Name:SOUTH QUEENS NEPHROLOGY ASSO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEPHROLOGY
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:RUZOL
Authorized Official - Last Name:AMARGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-651-9700
Mailing Address - Street 1:175-37 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-1325
Mailing Address - Country:US
Mailing Address - Phone:718-297-9100
Mailing Address - Fax:718-297-0625
Practice Address - Street 1:34-35 70TH STREET
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-651-9700
Practice Address - Fax:718-533-0264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty