Provider Demographics
NPI:1730785767
Name:SERENITY LASER OF BAY RIDGE, LLC
Entity type:Organization
Organization Name:SERENITY LASER OF BAY RIDGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRZHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-989-0601
Mailing Address - Street 1:479 BAY RIDGE PKWY UNIT 2C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2725
Mailing Address - Country:US
Mailing Address - Phone:718-989-0601
Mailing Address - Fax:929-345-2044
Practice Address - Street 1:479 BAY RIDGE PKWY UNIT 2C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2725
Practice Address - Country:US
Practice Address - Phone:718-989-0601
Practice Address - Fax:929-345-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty