| NAME |
QUEENS CBOC |
| STATE |
NEW YORK |
| STREET ADDR. 1 |
4701 QUEENS BLVD STE 301 |
| CITY |
SUNNYSIDE |
| ZIP |
11104-1623 |
| OFFICIAL VA NAME |
NORTH QUEENS CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
SUNNYSIDE VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1558309047
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
526GD |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 41-03 QUEENS BOULEVARD
- CITY (CHANGED FROM): QUEENS
- STATE (CHANGED FROM): NEW YORK
- ZIP (CHANGED FROM): 11104-2801
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1558309047
-
- CODING SYSTEM: VASTANUM
- ID: 526GD
-
- CODING SYSTEM: CLIA
- ID: 33D1040604
|
