Provider Demographics
NPI:1336855832
Name:ELMHURST 88 LLC
Entity Type:Organization
Organization Name:ELMHURST 88 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:QIANG
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-808-8769
Mailing Address - Street 1:8308 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5734
Mailing Address - Country:US
Mailing Address - Phone:347-808-8769
Mailing Address - Fax:347-808-8769
Practice Address - Street 1:8308 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5734
Practice Address - Country:US
Practice Address - Phone:347-808-8769
Practice Address - Fax:347-808-8769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicaid