MEDICARE: BAY RIDGE ORTHOPEDIC ASSOCIATES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	104095-1	NY

General Provider Information

NPI Number	:	1699882829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY RIDGE ORTHOPEDIC ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	476 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2702
Country	:	US
Telephone Number	:	914-305-4633
Fax Number	:	914-305-5587

Provider Business Practice Location Address
First Line	:	476 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2702
Country	:	US
Telephone Number	:	914-305-4633
Fax Number	:	914-305-5587

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	EHAB SANDUBY
Credential	:
Telephone Number	:	914-305-4633

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	08/22/2020

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