MEDICARE: ALTHEALTH PARK SLOPE LLC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	027602	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3350408	OTHER		OTHER ID NUMBER
2	3350408	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1790706760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTHEALTH PARK SLOPE LLC

Provider Business Mailing Address
First Line	:	1702 8TH AVE
Second Line	:	STE B
City	:	BROOKLYN
State	:	NY
Zip	:	11215-6104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 8TH AVE
Second Line	:	STE B
City	:	BROOKLYN
State	:	NY
Zip	:	11215-6104
Country	:	US
Telephone Number	:	718-788-2898
Fax Number	:	718-788-2703

Authorized Official
Title or Position	:	MGING MEMBER
Name	:	NELSON PANG
Credential	:
Telephone Number	:	718-788-2898

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	10/04/2007

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Directions to “ALTHEALTH PARK SLOPE LLC ” Practice Location

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