Healthcare Provider Details

I. General information

NPI: 1881779213
Provider Name (Legal Business Name): BAY RIDGE PHYSICIANS DIAGNOSTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 92 ST
BROOKLYN NY
11228
US

IV. Provider business mailing address

699 92 ST
BROOKLYN NY
11228
US

V. Phone/Fax

Practice location:
  • Phone: 718-567-1340
  • Fax: 718-567-1025
Mailing address:
  • Phone: 718-567-1340
  • Fax: 718-567-1025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: PRITPAL SINGH KANG
Title or Position: PRESIDENT
Credential: MD
Phone: 718-567-1340