Provider Demographics
NPI:1659672103
Name:BAY RIDGE MEDICAL CARE, LLC
Entity Type:Organization
Organization Name:BAY RIDGE MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDAYATNIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-833-4200
Mailing Address - Street 1:370 BAY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3164
Mailing Address - Country:US
Mailing Address - Phone:718-833-4200
Mailing Address - Fax:718-504-6055
Practice Address - Street 1:370 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3164
Practice Address - Country:US
Practice Address - Phone:718-833-4200
Practice Address - Fax:718-504-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-14
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251932261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical