Basic Information
| Provider Information | |||||||||
| NPI: | 1669623443 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUEES CONSULTAION CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9520 63RD RD | ||||||||
| Address2: | SUITE J | ||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113741145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184591225 | ||||||||
| FaxNumber: | 7184595805 | ||||||||
| Practice Location | |||||||||
| Address1: | 9520 63RD RD | ||||||||
| Address2: | STE J | ||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113741145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184591225 | ||||||||
| FaxNumber: | 7184595805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2008 | ||||||||
| LastUpdateDate: | 10/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | DAVIDOV | ||||||||
| AuthorizedOfficialFirstName: | LUDMILA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7184591225 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.