MEDICARE: PARK SLOPE DIAGNOSTIC BROOKLYN 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	213ER0200X	Radiology Podiatrist		NY

General Provider Information

NPI Number	:	1811361025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK SLOPE DIAGNOSTIC BROOKLYN INC

Provider Business Mailing Address
First Line	:	1243 60TH ST # 1RR
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4930
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1243 60TH ST # 1RR
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4930
Country	:	US
Telephone Number	:	347-633-3505
Fax Number	:

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

Provider Enumeration Date	:	11/26/2015
Last Update Date	:	11/26/2015

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Directions to “PARK SLOPE DIAGNOSTIC BROOKLYN INC ” Practice Location

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