Provider Demographics
NPI:1841323771
Name:PROMINIS MEDICAL SERVICES PC
Entity type:Organization
Organization Name:PROMINIS MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:718-852-5252
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:718-852-5252
Mailing Address - Fax:718-802-1113
Practice Address - Street 1:332 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3820
Practice Address - Country:US
Practice Address - Phone:718-852-5252
Practice Address - Fax:718-802-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02617105Medicaid
NYDD0279OtherRAILROAD MEDICARE
NY02617105Medicaid