| NPI | 1619539996 |
|---|---|
| Former Legal Business Name | QUEENS BOULEVARD EXTENDED CARE DIALYSIS CENTER LLC |
| Entity Type | Organization |
| Authorized Contact | JAMES CLEMENZA Managing Member 718-205-0287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2021-12-15 |