Provider Demographics
NPI:1336372671
Name:BAY RIDGE MEDICAL IMAGING, PC
Entity Type:Organization
Organization Name:BAY RIDGE MEDICAL IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHROKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-238-7000
Mailing Address - Street 1:7601 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3207
Mailing Address - Country:US
Mailing Address - Phone:718-238-7000
Mailing Address - Fax:718-238-7005
Practice Address - Street 1:1220 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1009
Practice Address - Country:US
Practice Address - Phone:718-375-1300
Practice Address - Fax:718-238-7005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAY RIDGE MEDICAL IMAGING, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02390045Medicaid
NY02390045Medicaid