Provider Demographics
NPI:1154540599
Name:BAY PARKWAY ALL TYPES OF DENTISTRY PC
Entity type:Organization
Organization Name:BAY PARKWAY ALL TYPES OF DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:V
Authorized Official - Last Name:ANDREYEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-236-4422
Mailing Address - Street 1:2211 A 65 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:718-236-4422
Mailing Address - Fax:718-236-6730
Practice Address - Street 1:2211 A 65 STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:718-236-4422
Practice Address - Fax:718-236-6730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0450321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01485794Medicaid