MEDICARE: BAY RIDGE 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1790008407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY RIDGE SERVICES INC

Provider Business Mailing Address
First Line	:	2781 OCEAN AVE
Second Line	:	SUITE BB
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4749
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2781 OCEAN AVE
Second Line	:	SUITE BB
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4749
Country	:	US
Telephone Number	:	718-648-0705
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KEVIN CLARK
Credential	:
Telephone Number	:	718-648-0705

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	03/09/2010

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