Provider Demographics
NPI:1639332281
Name:BAY RIDGE SKIN AND CANCER DERMATOLOGY, PC
Entity Type:Organization
Organization Name:BAY RIDGE SKIN AND CANCER DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-833-7616
Mailing Address - Street 1:9921 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-8347
Mailing Address - Country:US
Mailing Address - Phone:718-833-7616
Mailing Address - Fax:
Practice Address - Street 1:9921 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-8347
Practice Address - Country:US
Practice Address - Phone:718-833-7616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194876207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty