Queens Dialysis at the Pavilion, LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

QUEENS DIALYSIS AT THE PAVILION, LLC

Practice address

36-17 Parsons Blvd
Flushing, NY 11354-5931

Phone

(718) 961-4300

NPI assigned

Dec 16, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joel Edelstein

Title

Manager

Phone

(718) 888-5206

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Listed as

Queens Dialysis at the Pavilion, LLCCCN 332659

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Jun 11, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

12

Tax ID family

Flushing Manor Dialysis Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Flushing Manor Dialysis Center, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Flushing, NY
  • NPI 1285843904
  NPD tax ID

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Salim Albert Khoury, M.D.

  • Nephrology Physician
  • Flushing, NY
  • NPI 1811963002

  Dialysis facility

  Care Compare affiliation Name & address match
• Elizabeth Liang, M.D.

  • Nephrology Physician
  • Flushing, NY
  • NPI 1740406206

  Dialysis facility

  Care Compare affiliation Name & address match
• Ritesh Raichoudhury, M.D.

  • Nephrology Physician
  • Flushing, NY
  • NPI 1659304756

  Dialysis facility

  Care Compare affiliation Name & address match

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1275931644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36-17 PARSONS BLVD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113545931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36-17 PARSONS BLVD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113545931",
            "telephone_number": "718-961-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEENS DIALYSIS AT THE PAVILION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-16",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A",
        "authorized_official_last_name": "EDELSTEIN",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "718-888-5206"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2991431",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Queens Hearing Center, Inc.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Flushing, NY
• Providers in Flushing, NY by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.