Provider Demographics
NPI:1104994540
Name:BRYAN G. FORLEY, M.D., P.C.
Entity type:Organization
Organization Name:BRYAN G. FORLEY, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:FORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-861-3757
Mailing Address - Street 1:5 EAST 82ND STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028
Mailing Address - Country:US
Mailing Address - Phone:212-861-3757
Mailing Address - Fax:212-861-5033
Practice Address - Street 1:5 E 82ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0342
Practice Address - Country:US
Practice Address - Phone:212-861-3757
Practice Address - Fax:212-861-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168207208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01450811Medicaid
NY01450811Medicaid
NYF70404Medicare UPIN