Healthcare Provider Details

I. General information

NPI: 1720859747
Provider Name (Legal Business Name): BAY RIDGE MED ARTS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 3RD AVE
BROOKLYN NY
11209-1306
US

IV. Provider business mailing address

7015 3RD AVE
BROOKLYN NY
11209-1306
US

V. Phone/Fax

Practice location:
  • Phone: 917-859-7331
  • Fax:
Mailing address:
  • Phone: 917-859-7331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: IRISA MEZORE
Title or Position: OWNER
Credential: FNP
Phone: 917-859-7331