Provider Demographics
NPI:1255316246
Name:SOUTH QUEENS NEPHROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH QUEENS NEPHROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEPHROLOGY
Authorized Official - Prefix:DR
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:718-297-9100
Mailing Address - Street 1:17537 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 1:17537 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-1325
Practice Address - Country:US
Practice Address - Phone:718-297-9100
Practice Address - Fax:718-297-0625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherEMPLOYER IDENTIFICATION N