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General NPI Number Information
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NPI Number | 1649615055
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Entity Type | Organization
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Legal Business Name | BAY RIDGE PEDIATRICS AND ADOLESCENTS OFFICE PC
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 217 73RD ST 1 ST FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11209-2109
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Country | US
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Telephone | 718-921-0074
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Fax |
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Provider Business Mailing Address
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Address Line | 217 73 ED STREET 1 ST FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11209-2109
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Country | US
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Telephone | 718-921-0074
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ABDULLA ALWANI
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Credential | M.D.
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Telephone | 171-892-0074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 166458
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License Number State | NY
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