Club 55 Prestige

Primary specialty

Respite CareTaxonomy code 385H00000X

Legal business name

CLUB 55 PRESTIGE

Practice address

6408 Fleet St
Rego Park, NY 11374-5244

Phone

(718) 275-5275

Fax

(718) 275-2652

NPI assigned

Feb 24, 2017

Organization subpart

No

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

Authorized official

Name

Lydia MusheyevNPI 1407239106

Title

Owner-Director

Phone

(718) 812-8112

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lydia Musheyev

  • Respite Care
  • Rego Park, NY
  • NPI 1407239106
  NPD (past) Authorized official

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

{
    "created_epoch": "1487894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487894400000",
    "number": "1912447905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9707 63RD RD APT 3N",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113741610",
            "telephone_number": "718-275-5275",
            "fax_number": "718-275-2652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6408 FLEET ST",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113745244",
            "telephone_number": "718-275-5275",
            "fax_number": "718-275-2652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLUB 55 PRESTIGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-24",
        "last_updated": "2017-02-24",
        "status": "A",
        "authorized_official_last_name": "MUSHEYEV",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_title_or_position": "OWNER-DIRECTOR",
        "authorized_official_telephone_number": "718-812-8112"
    },
    "taxonomies": [
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latosha Clark, LMSW
• Morgan Clark, LSW
• Claire Clarke-Browne
• Joanne Ineson Clarvit, LCSW
• CLT Dentistry, PLLC
• Cohen Medical Practice PC
• Igor E Cohen, MD
• Meir S. Cohen, D.O.
• Cole Vision Corporation (Sears Optical #C1051)
• Marcia Rene Cole

• Respite Care in Rego Park, NY
• Providers in Rego Park, NY by specialty
• Respite Care in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2017; 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.