Provider Demographics
NPI:1710992482
Name:DOUGLAS H BAILYN, MD, PC
Entity Type:Organization
Organization Name:DOUGLAS H BAILYN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:BAILYN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-777-1510
Mailing Address - Street 1:47 PLAZA ST W
Mailing Address - Street 2:APT. 11A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3905
Mailing Address - Country:US
Mailing Address - Phone:212-571-3331
Mailing Address - Fax:212-375-0539
Practice Address - Street 1:380 2ND AVE
Practice Address - Street 2:SUITE 1002
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5615
Practice Address - Country:US
Practice Address - Phone:212-777-1510
Practice Address - Fax:212-375-0539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222452207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02654117Medicaid
NYWHW751Medicare PIN
NYI28780Medicare UPIN