Healthcare Provider Details

I. General information

NPI: 1427321413
Provider Name (Legal Business Name): BROOKLYN PREMIER CARDIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7509 13TH AVE
BROOKLYN NY
11228-2409
US

IV. Provider business mailing address

7509 13TH AVE
BROOKLYN NY
11228-2409
US

V. Phone/Fax

Practice location:
  • Phone: 718-256-6800
  • Fax: 718-256-6822
Mailing address:
  • Phone: 718-256-6800
  • Fax: 718-256-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number246915
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number246915
License Number StateNY

VIII. Authorized Official

Name: DAVID P. FUSCHETTO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-256-6800