Provider Demographics
NPI:1083936017
Name:QUEENS BOROUGH DAY CARE, LLC
Entity Type:Organization
Organization Name:QUEENS BOROUGH DAY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TSEPENYUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-353-1740
Mailing Address - Street 1:61-04 LAUREL HILL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5864
Mailing Address - Country:US
Mailing Address - Phone:718-353-1740
Mailing Address - Fax:718-353-4902
Practice Address - Street 1:61-04 LAUREL HILL BOULEVARD
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:718-353-1740
Practice Address - Fax:718-353-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care