Basic Information
| Provider Information | |||||||||
| NPI: | 1043251390 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARK SLOPE EMERGENCY PHYSICIAN SERVICES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5464 | ||||||||
| Address2: | PARK SLOPE EMERGENCY PHYSICIAN SERVICES PC | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100875464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006662455 | ||||||||
| FaxNumber: | 6106176280 | ||||||||
| Practice Location | |||||||||
| Address1: | 506 6TH ST | ||||||||
| Address2: | NEW YORK METHODIST HOSPITAL | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112153609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187803424 | ||||||||
| FaxNumber: | 7187807294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 10/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | BOVE | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7187803159 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00944927 | 05 | NY | MEDICAID |