MEDICARE: BAY RIDGE FAMILY HEALTH NP, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1477383719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY RIDGE FAMILY HEALTH NP, PLLC

Provider Business Mailing Address
First Line	:	7015 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1306
Country	:	US
Telephone Number	:	917-859-7331
Fax Number	:

Provider Business Practice Location Address
First Line	:	7015 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1306
Country	:	US
Telephone Number	:	917-859-7331
Fax Number	:

Authorized Official
Title or Position	:	FNP
Name	:	IRISA MEZORE
Credential	:	FNP
Telephone Number	:	917-859-3331

Provider Enumeration Date	:	08/02/2024
Last Update Date	:	10/24/2024

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