Provider Demographics
NPI:1528272275
Name:BAY RIDGE SUNSET PARK DIALYSIS CENTER
Entity type:Organization
Organization Name:BAY RIDGE SUNSET PARK DIALYSIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-567-0255
Mailing Address - Street 1:140 58TH ST BLDG B
Mailing Address - Street 2:SUITE 1 I
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2521
Mailing Address - Country:US
Mailing Address - Phone:718-567-0255
Mailing Address - Fax:718-567-0288
Practice Address - Street 1:140 58TH ST BLDG B
Practice Address - Street 2:SUITE 1 I
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2521
Practice Address - Country:US
Practice Address - Phone:718-567-0255
Practice Address - Fax:718-567-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332560261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY332560OtherDIALYSIS PROVIDER NUMBER