Provider Demographics
NPI:1851662431
Name:BRIDGEVIEW NEUROMED CARE PC
Entity Type:Organization
Organization Name:BRIDGEVIEW NEUROMED CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YONGMING
Authorized Official - Middle Name:
Authorized Official - Last Name:MAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-375-3738
Mailing Address - Street 1:829 57TH ST
Mailing Address - Street 2:5FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3677
Mailing Address - Country:US
Mailing Address - Phone:718-375-3738
Mailing Address - Fax:718-686-0188
Practice Address - Street 1:829 57TH ST
Practice Address - Street 2:5FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3677
Practice Address - Country:US
Practice Address - Phone:718-375-3738
Practice Address - Fax:718-686-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233817174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02758881Medicaid