MEDICARE: PARK SLOPE DIAGNOSTIC INC

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	2471S1302X	Sonography Radiologic Technologist	129281	NY
2	2471V0105X	Vascular Sonography Radiologic Technologist	129281	NY

General Provider Information

NPI Number	:	1508232489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK SLOPE DIAGNOSTIC INC

Provider Business Mailing Address
First Line	:	1243 60TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4930
Country	:	US
Telephone Number	:	347-633-3505
Fax Number	:

Provider Business Practice Location Address
First Line	:	1243 60TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4930
Country	:	US
Telephone Number	:	347-633-3505
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	VIMAL H BHATT
Credential	:	NA
Telephone Number	:	347-633-3505

Provider Enumeration Date	:	08/14/2015
Last Update Date	:	08/14/2015

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