Healthcare Provider Details

I. General information

NPI: 1316203490
Provider Name (Legal Business Name): BAYVIEW PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BAY 29 STREET, 2A
BROOKLYN NY
11214
US

IV. Provider business mailing address

15 BAY 29 STREET, 2 A
BROOKLYN NY
11214
US

V. Phone/Fax

Practice location:
  • Phone: 718-266-7700
  • Fax: 718-266-7100
Mailing address:
  • Phone: 718-266-7700
  • Fax: 718-266-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number005475
License Number StateNY

VIII. Authorized Official

Name: DR. TERENCE SAADVANDI
Title or Position: PRESIDENT
Credential: DPM
Phone: 718-266-7700