NPIMap

Organization Active NPI

Queens Blvd Ext Care Facility Management LLC

  • Skilled Nursing Facility
  • Woodside, NY
National Provider Identifier
1376943761
Registry record updated Dec 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
QUEENS BLVD EXT CARE FACILITY MANAGEMENT LLC
Practice address
6111 Queens Blvd
Woodside, NY 11377-4965
Phone
(718) 205-0298
NPI assigned
Sep 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

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

Authorized official

Name
Mr. Joseph Malone
Title
Cfo
Phone
(718) 205-0298

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X 703410N NY
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

6111 Queens Blvd
Woodside, NY 11377-4965

Mailing address

6111 Queens Blvd
Woodside, NY 11377-4965
Phone (718) 205-0298

Other identifiers 1

IdentifierTypeStateIssuer
2996110MedicaidNY

Other names 1

  • Queens Blvd Ext Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Queens Blvd Ext Care4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1409788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639526400000",
    "number": "1376943761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6111 QUEENS BLVD",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113774965",
            "telephone_number": "718-205-0298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6111 QUEENS BLVD",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113774965",
            "telephone_number": "718-205-0298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEENS BLVD EXT CARE FACILITY MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-04",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A",
        "authorized_official_last_name": "MALONE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "718-205-0298",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "NY",
            "license": "703410N",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2996110",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Queens Blvd Ext Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Queens Blvd Ext Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodside, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.