Provider Demographics
NPI:1679747430
Name:BAY RIDGE HEARTS CARDIOVASCULAR CARE, PC
Entity type:Organization
Organization Name:BAY RIDGE HEARTS CARDIOVASCULAR CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:V
Authorized Official - Last Name:FERNAINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-238-0098
Mailing Address - Street 1:217 OVINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1204
Mailing Address - Country:US
Mailing Address - Phone:718-238-0098
Mailing Address - Fax:718-836-6849
Practice Address - Street 1:217 OVINGTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1204
Practice Address - Country:US
Practice Address - Phone:718-238-0098
Practice Address - Fax:718-836-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122899207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00679929Medicaid
NYA100000054Medicare UPIN