Healthcare Provider Details

I. General information

NPI: 1598041394
Provider Name (Legal Business Name): PARKSIDE MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 PARKSIDE AVE APT 1D
BROOKLYN NY
11226-1317
US

IV. Provider business mailing address

225 PARKSIDE AVE APT 1D
BROOKLYN NY
11226-1317
US

V. Phone/Fax

Practice location:
  • Phone: 718-469-4222
  • Fax:
Mailing address:
  • Phone: 718-469-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ADEOLA UTHMAN
Title or Position: OWNER
Credential:
Phone: 718-469-4222