MEDICARE: SERENITY LASER OF BAY RIDGE, LLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1730785767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY LASER OF BAY RIDGE, LLC

Provider Business Mailing Address
First Line	:	479 BAY RIDGE PKWY UNIT 2C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2725
Country	:	US
Telephone Number	:	718-989-0601
Fax Number	:	929-345-2044

Provider Business Practice Location Address
First Line	:	479 BAY RIDGE PKWY UNIT 2C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2725
Country	:	US
Telephone Number	:	718-989-0601
Fax Number	:	929-345-2044

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALEXANDER KIRZHNER
Credential	:	DDS
Telephone Number	:	718-989-0601

Provider Enumeration Date	:	12/06/2020
Last Update Date	:	12/06/2020

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