Healthcare Provider Details

I. General information

NPI: 1679747430
Provider Name (Legal Business Name): BAY RIDGE HEARTS CARDIOVASCULAR CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 OVINGTON AVE
BROOKLYN NY
11209-1204
US

IV. Provider business mailing address

217 OVINGTON AVE
BROOKLYN NY
11209-1204
US

V. Phone/Fax

Practice location:
  • Phone: 718-238-0098
  • Fax: 718-836-6849
Mailing address:
  • Phone: 718-238-0098
  • Fax: 718-836-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number122899
License Number StateNY

VIII. Authorized Official

Name: DR. ANTOINE V FERNAINE
Title or Position: PRESIDENT
Credential: MD
Phone: 718-238-0098