Provider Demographics
NPI:1427321413
Name:BROOKLYN PREMIER CARDIOLOGY PC
Entity type:Organization
Organization Name:BROOKLYN PREMIER CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:FUSCHETTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-256-6800
Mailing Address - Street 1:7509 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2409
Mailing Address - Country:US
Mailing Address - Phone:718-256-6800
Mailing Address - Fax:718-256-6822
Practice Address - Street 1:7509 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2409
Practice Address - Country:US
Practice Address - Phone:718-256-6800
Practice Address - Fax:718-256-6822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246915207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty