Provider Demographics
NPI:1285981944
Name:BAY RIDGE CREATIONS, INC
Entity type:Organization
Organization Name:BAY RIDGE CREATIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANOSHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-445-0900
Mailing Address - Street 1:260 65TH ST APT 22P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-6501
Mailing Address - Country:US
Mailing Address - Phone:347-445-0900
Mailing Address - Fax:718-833-9778
Practice Address - Street 1:260 65TH ST APT 22P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-6501
Practice Address - Country:US
Practice Address - Phone:347-445-0900
Practice Address - Fax:718-833-9778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-12
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency