Provider Demographics
NPI:1811345101
Name:BISYATA DISHMAYA MANAGEMENT SERVICES INC.
Entity type:Organization
Organization Name:BISYATA DISHMAYA MANAGEMENT SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDORTHIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:D
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:LEFT DOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2331
Mailing Address - Country:US
Mailing Address - Phone:718-782-0600
Mailing Address - Fax:718-305-7001
Practice Address - Street 1:910 46TH STREET
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-782-0600
Practice Address - Fax:718-305-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NYC36411224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty