Provider Demographics
NPI:1194608281
Name:PROMINIS CARE IPA, LLC
Entity type:Organization
Organization Name:PROMINIS CARE IPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FENYVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-780-1001
Mailing Address - Street 1:381 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2806
Mailing Address - Country:US
Mailing Address - Phone:718-669-7635
Mailing Address - Fax:607-203-9585
Practice Address - Street 1:6451 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6258
Practice Address - Country:US
Practice Address - Phone:718-669-7635
Practice Address - Fax:607-203-9585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty