Provider Demographics
NPI:1114176864
Name:BAISLEY MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:BAISLEY MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELERME-PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-484-8985
Mailing Address - Street 1:20215 46TH RD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3059
Mailing Address - Country:US
Mailing Address - Phone:646-460-2959
Mailing Address - Fax:
Practice Address - Street 1:321 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-4101
Practice Address - Country:US
Practice Address - Phone:718-484-8985
Practice Address - Fax:718-484-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198983261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02458597Medicaid