MEDICARE: PARK SLOPE SPECIALIZED SERVICES LLC

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	261QE0800X	Endoscopy Clinic/Center

General Provider Information

NPI Number	:	1801050471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK SLOPE SPECIALIZED SERVICES LLC

Provider Business Mailing Address
First Line	:	1224 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1224 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5106
Country	:	US
Telephone Number	:	718-788-5588
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ASIM MALIK
Credential	:	M.D.
Telephone Number	:	718-788-5588

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	07/14/2008

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