Healthcare Provider Details

I. General information

NPI: 1518476985
Provider Name (Legal Business Name): PARK SLEEP VIP & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 PARK AVE
NEW YORK NY
10016-2557
US

IV. Provider business mailing address

2102 BAY RIDGE PKWY
BROOKLYN NY
11204-5945
US

V. Phone/Fax

Practice location:
  • Phone: 718-684-6393
  • Fax: 718-684-6995
Mailing address:
  • Phone: 718-684-6393
  • Fax: 718-684-6395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number234613
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number234613
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number234613
License Number StateNY

VIII. Authorized Official

Name: DR. STEVE SLOBOSKI
Title or Position: GENERAL PARTNER
Credential: DDS
Phone: 718-684-6393