MEDICARE: SLOPE PEDIATRICS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	3823999-1	NY

General Provider Information

NPI Number	:	1013450931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLOPE PEDIATRICS

Provider Business Mailing Address
First Line	:	60 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3940
Country	:	US
Telephone Number	:	718-636-0019
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3940
Country	:	US
Telephone Number	:	718-636-0019
Fax Number	:

Authorized Official
Title or Position	:	PEDIATRIC NURSE PRACTITIONER
Name	:	REEZA BIALA
Credential	:	PNP
Telephone Number	:	718-630-0019

Provider Enumeration Date	:	11/25/2016
Last Update Date	:	11/25/2016

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