Provider Demographics
NPI:1134583123
Name:BOULEVARD ADULT DAY CARE OF FLUSHING
Entity type:Organization
Organization Name:BOULEVARD ADULT DAY CARE OF FLUSHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MARX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-887-9944
Mailing Address - Street 1:4234 SAULL ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4543
Mailing Address - Country:US
Mailing Address - Phone:718-887-9944
Mailing Address - Fax:718-650-6011
Practice Address - Street 1:4101 75TH ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1851
Practice Address - Country:US
Practice Address - Phone:718-887-9944
Practice Address - Fax:718-650-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care