Healthcare Provider Details

I. General information

NPI: 1659857266
Provider Name (Legal Business Name): BAILEY OUTPATIENT MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 BAYVIEW AVE
BALDWIN NY
11510-4451
US

IV. Provider business mailing address

PO BOX 529
BALDWIN NY
11510-0529
US

V. Phone/Fax

Practice location:
  • Phone: 516-342-3422
  • Fax: 347-331-0526
Mailing address:
  • Phone: 718-601-1713
  • Fax: 718-601-1712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: MS. DIMITRA DENISE PALLIS
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 201-874-9084