Healthcare Provider Details

I. General information

NPI: 1649105172
Provider Name (Legal Business Name): OMNIA-CARDIOVASCULAR PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7404 5TH AVE
BROOKLYN NY
11209-2704
US

IV. Provider business mailing address

1722 PITKIN AVE
BROOKLYN NY
11212-6604
US

V. Phone/Fax

Practice location:
  • Phone: 929-999-5709
  • Fax:
Mailing address:
  • Phone: 929-999-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: JOHN LEE
Title or Position: OWNER
Credential: MD
Phone: 347-427-5655