MEDICARE: BAY RIDGE MED ARTS CORP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363LW0102X	Women's Health Nurse Practitioner
2	2083P0901X	Public Health & General Preventive Medicine Physician
3	363L00000X	Nurse Practitioner
4	363LP2300X	Primary Care Nurse Practitioner
5	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1720859747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY RIDGE MED ARTS CORP

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	:	OWNER
Name	:	IRISA MEZORE
Credential	:	FNP
Telephone Number	:	917-859-7331

Provider Enumeration Date	:	01/09/2024
Last Update Date	:	04/04/2024

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Directions to “BAY RIDGE MED ARTS CORP ” Practice Location

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