Healthcare Provider Details

I. General information

NPI: 1811345101
Provider Name (Legal Business Name): BISYATA DISHMAYA MANAGEMENT SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 46TH STREET GROUND FLOOR
BROOKLYN NY
11219
US

IV. Provider business mailing address

928 46TH ST LEFT DOOR
BROOKLYN NY
11219-2331
US

V. Phone/Fax

Practice location:
  • Phone: 718-782-0600
  • Fax: 718-305-7001
Mailing address:
  • Phone: 718-782-0600
  • Fax: 718-305-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberC36411
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL D TEITELBAUM
Title or Position: PEDORTHIST
Credential: C-PED
Phone: 718-782-0600