Provider Demographics
NPI:1205957446
Name:SOUTH QUEENS DIALYSIS CENTER
Entity type:Organization
Organization Name:SOUTH QUEENS DIALYSIS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SLIFKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-626-8947
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:2007-04-03
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY332531Medicare Oscar/Certification