Provider Demographics
NPI:1396786695
Name:BAY MEDICAL CARE P.C.
Entity type:Organization
Organization Name:BAY MEDICAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVE
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:DRIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:718-232-1910
Mailing Address - Street 1:7612 BAY PKWY
Mailing Address - Street 2:SUITE# B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1516
Mailing Address - Country:US
Mailing Address - Phone:718-232-1910
Mailing Address - Fax:718-232-1932
Practice Address - Street 1:7612 BAY PKWY
Practice Address - Street 2:SUITE# B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1516
Practice Address - Country:US
Practice Address - Phone:718-232-1910
Practice Address - Fax:718-232-1932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186334323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF86028Medicare UPIN
NY96F731Medicare ID - Type Unspecified