Healthcare Provider Details

I. General information

NPI: 1255875597
Provider Name (Legal Business Name): BAY RIDGE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6935 4TH AVE
BROOKLYN NY
11209-1501
US

IV. Provider business mailing address

411 OVINGTON AVE
BROOKLYN NY
11209-1504
US

V. Phone/Fax

Practice location:
  • Phone: 718-748-0650
  • Fax: 718-680-5143
Mailing address:
  • Phone: 718-748-0650
  • Fax: 718-680-5143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number StateNY

VIII. Authorized Official

Name: MS. MARIANNE NICOLOSI
Title or Position: EXECUTIVE DIRECTOR
Credential: L.M.S.W.
Phone: 718-748-0650