Provider Demographics
NPI:1417922808
Name:CENTRAL QUEENS DAY SURGICAL CENTER, INC.
Entity Type:Organization
Organization Name:CENTRAL QUEENS DAY SURGICAL CENTER, INC.
Other - Org Name:QUEENS SURGI-CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-849-8700
Mailing Address - Street 1:8340 WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7824
Mailing Address - Country:US
Mailing Address - Phone:718-849-8700
Mailing Address - Fax:718-849-6523
Practice Address - Street 1:8340 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7824
Practice Address - Country:US
Practice Address - Phone:718-849-8700
Practice Address - Fax:718-849-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003242R261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01373564Medicaid
NY01373564Medicaid