MEDICARE: PARK SLOPE MEDICINE, 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
1	225X00000X	Occupational Therapist	000000	NY
2	225100000X	Physical Therapist	000000	NY

General Provider Information

NPI Number	:	1508279852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK SLOPE MEDICINE, PC

Provider Business Mailing Address
First Line	:	PO BOX 5450
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-5450
Country	:	US
Telephone Number	:	718-780-3284
Fax Number	:

Provider Business Practice Location Address
First Line	:	4911 13TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3135
Country	:	US
Telephone Number	:	718-946-8041
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	STANLEY SHERBELL
Credential	:	MD
Telephone Number	:	718-780-3284

Provider Enumeration Date	:	06/04/2014
Last Update Date	:	06/04/2014

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