Provider Demographics
NPI:1700035169
Name:BISYATA DISHMAYA MANAGEMENT SERVICES INC.
Entity Type:Organization
Organization Name:BISYATA DISHMAYA MANAGEMENT SERVICES INC.
Other - Org Name:TEITELBAUM C-PED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDORTHIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TEITELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:C-PED
Authorized Official - Phone:718-782-0600
Mailing Address - Street 1:928 46TH ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2332
Mailing Address - Country:US
Mailing Address - Phone:718-782-0600
Mailing Address - Fax:718-782-0611
Practice Address - Street 1:166 ROSS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7737
Practice Address - Country:US
Practice Address - Phone:718-782-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BISYATA DISHMAYA MANAGEMENT SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-10
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6039400001Medicare NSC