Provider Demographics
NPI:1306885470
Name:BAILYN, DOUGLAS HARRY (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:HARRY
Last Name:BAILYN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:47 PLAZA ST W
Mailing Address - Street 2:APT. 11A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3905
Mailing Address - Country:US
Mailing Address - Phone:212-571-3331
Mailing Address - Fax:212-375-0539
Practice Address - Street 1:380 2ND AVE
Practice Address - Street 2:SUITE 1002
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5615
Practice Address - Country:US
Practice Address - Phone:212-571-3331
Practice Address - Fax:212-375-0539
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2008-04-02
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Provider Licenses
StateLicense IDTaxonomies
NY222452207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02654117Medicaid
NY7X178HW751Medicare PIN
NY02654117Medicaid