Healthcare Provider Details

I. General information

NPI: 1144409269
Provider Name (Legal Business Name): THOMAS BUSTROS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 OVINGTON AVE BAY RIDGE HEARTS
BROOKLYN NY
11209-1204
US

IV. Provider business mailing address

217 OVINGTON AVE BAY RIDGE HEARTS
BROOKLYN NY
11209-1204
US

V. Phone/Fax

Practice location:
  • Phone: 718-238-0098
  • Fax:
Mailing address:
  • Phone: 718-238-0098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number242654
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number242654
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: