Healthcare Provider Details

I. General information

NPI: 1023211133
Provider Name (Legal Business Name): BIMC FACULTY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 MANHATTAN AVE
BROOKLYN NY
11222-2539
US

IV. Provider business mailing address

851 MANHATTAN AVE
BROOKLYN NY
11222-2539
US

V. Phone/Fax

Practice location:
  • Phone: 718-752-7280
  • Fax:
Mailing address:
  • Phone: 718-752-7280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH HACKETT
Title or Position: AVP
Credential:
Phone: 212-256-3424