MEDICARE: BISYATA DISHMAYA MANAGEMENT SERVICES INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1700035169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BISYATA DISHMAYA MANAGEMENT SERVICES INC.

Provider Business Mailing Address
First Line	:	928 46TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2331
Country	:	US
Telephone Number	:	718-782-0600
Fax Number	:	718-782-0611

Provider Business Practice Location Address
First Line	:	326 WALLABOUT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206
Country	:	US
Telephone Number	:	718-782-0600
Fax Number	:

Authorized Official
Title or Position	:	PEDORTHIST
Name	:	SAMUEL TEITELBAUM
Credential	:	C-PED
Telephone Number	:	718-782-0600

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	04/07/2026

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