Provider Demographics
NPI:1083220123
Name:QUEENS SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:QUEENS SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-592-1120
Mailing Address - Street 1:3636 MAIN ST STE 1S
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6517
Mailing Address - Country:US
Mailing Address - Phone:347-592-1120
Mailing Address - Fax:800-550-4779
Practice Address - Street 1:3636 MAIN ST STE 1S
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6517
Practice Address - Country:US
Practice Address - Phone:347-592-1120
Practice Address - Fax:800-550-4779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical