Basic Information
| Provider Information | |||||||||
| NPI: | 1740628478 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARK SLOPE MEDICINE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5450 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100875450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885422842 | ||||||||
| FaxNumber: | 7324401483 | ||||||||
| Practice Location | |||||||||
| Address1: | 2281 82ND ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112142603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3474621914 | ||||||||
| FaxNumber: | 8885382577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2013 | ||||||||
| LastUpdateDate: | 06/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | SHERBELL | ||||||||
| AuthorizedOfficialFirstName: | STANLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7187803284 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.