Provider Demographics
NPI:1659857266
Name:BAILEY OUTPATIENT MEDICAL SERVICES
Entity Type:Organization
Organization Name:BAILEY OUTPATIENT MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:DIMITRA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:PALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-874-9084
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-0529
Mailing Address - Country:US
Mailing Address - Phone:718-601-1713
Mailing Address - Fax:718-601-1712
Practice Address - Street 1:2901 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4451
Practice Address - Country:US
Practice Address - Phone:516-342-3422
Practice Address - Fax:347-331-0526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty