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General NPI Number Information
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NPI Number | 1255875597
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Entity Type | Organization
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Legal Business Name | BAY RIDGE CENTER, INC
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 6935 4TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-1501
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Country | US
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Telephone | 718-748-0650
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Fax | 718-680-5143
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Provider Business Mailing Address
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Address Line | 411 OVINGTON AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-1504
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Country | US
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Telephone | 718-748-0650
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Fax | 718-680-5143
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. MARIANNE NICOLOSI
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Credential | L.M.S.W.
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Telephone | 718-748-0650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 347B00000X
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Taxonomy Name | Bus
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License Number |
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State | NY
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