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NPI Code Detail

MEDICARE: PARK SLOPE MEDICAL OFFICE PC

MEDICARE: PARK SLOPE MEDICAL OFFICE PC
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
1174400000XSpecialist168069NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871545566
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARK SLOPE MEDICAL OFFICE PC
Provider Business Mailing Address
First Line : 9322 3RD AVE
Second Line : STE 504
City : BROOKLYN
State : NY
Zip : 11209-6802
Country : US
Telephone Number : 718-832-1964
Fax Number : 718-832-0526
Provider Business Practice Location Address
First Line : 3443 83RD ST
Second Line :
City : JACKSON HEIGHTS
State : NY
Zip : 11372-3054
Country : US
Telephone Number : 718-832-1964
Fax Number : 718-832-0526
Authorized Official
Title or Position : OWNER
Name : DR. ANJAN RAU
Credential : M.D
Telephone Number : 718-832-1964
Provider Enumeration Date : 05/17/2006
Last Update Date : 03/31/2008

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Directions to “PARK SLOPE MEDICAL OFFICE PC ” Practice Location

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