MEDICARE: BAY RIDGE PRIMARY CARE

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1710046412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY RIDGE PRIMARY CARE

Provider Business Mailing Address
First Line	:	511 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3309
Country	:	US
Telephone Number	:	718-283-8773
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RICHARD FUNARO
Credential	:	MD
Telephone Number	:	718-283-8773

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	08/22/2020

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