=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487998241
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BD O&P
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2012
-----------------------------------------------------
Last Update Date | 11/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 943 46TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11219-2332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-437-3200
-----------------------------------------------------
Fax | 718-483-8057
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 943 46TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11219-2332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-437-3200
-----------------------------------------------------
Fax | 718-483-8057
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SAMUEL D TEITELBAUM
-----------------------------------------------------
Credential | C-PED
-----------------------------------------------------
Telephone | 718-437-3200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | C36411
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------