Healthcare Provider Details

I. General information

NPI: 1811065915
Provider Name (Legal Business Name): PARK SLOPE MEDICAL NY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 13TH ST
BROOKLYN NY
11215-5004
US

IV. Provider business mailing address

348 13TH ST
BROOKLYN NY
11215
US

V. Phone/Fax

Practice location:
  • Phone: 718-499-2741
  • Fax: 718-499-2704
Mailing address:
  • Phone: 718-499-2741
  • Fax: 718-499-2704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. MARTHA ANTHONY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 718-499-2741