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General NPI Number Information
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NPI Number | 1457658031
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Entity Type | Organization
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Legal Business Name | PARK SLOPE MEDICAL ASSOCIATES PC
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 348 13TH ST SUITE 103
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City | BROOKLYN
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State | NY
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Zip | 11215-6177
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Country | US
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Telephone | 718-499-4400
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Fax | 718-499-2704
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Provider Business Mailing Address
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Address Line | 348 13TH ST SUITE 103
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City | BROOKLYN
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State | NY
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Zip | 11215-6177
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Country | US
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Telephone | 718-499-4400
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Fax | 718-499-2704
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. VARUZHAN DOVLATYAN
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Credential | MD
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Telephone | 718-499-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 207890-1
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License Number State | NY
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