Provider Demographics
NPI:1699882829
Name:BAY RIDGE ORTHOPEDIC ASSOCIATES, PC
Entity type:Organization
Organization Name:BAY RIDGE ORTHOPEDIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDUBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-305-4633
Mailing Address - Street 1:476 BAY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2702
Mailing Address - Country:US
Mailing Address - Phone:914-305-4633
Mailing Address - Fax:914-305-5587
Practice Address - Street 1:476 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2702
Practice Address - Country:US
Practice Address - Phone:914-305-4633
Practice Address - Fax:914-305-5587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104095-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty