Provider Demographics
NPI:1669816187
Name:OBGYN CARE OF BAY RIDGE
Entity Type:Organization
Organization Name:OBGYN CARE OF BAY RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBDEWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-833-8370
Mailing Address - Street 1:568 BAY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3310
Mailing Address - Country:US
Mailing Address - Phone:718-833-8370
Mailing Address - Fax:718-833-1657
Practice Address - Street 1:568 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3310
Practice Address - Country:US
Practice Address - Phone:718-833-8370
Practice Address - Fax:718-833-1657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210759207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01828046Medicaid