Provider Demographics
NPI:1215989116
Name:PARK SLOPE MEDICINE, P.C.
Entity type:Organization
Organization Name:PARK SLOPE MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-780-3877
Mailing Address - Street 1:PO BOX 5450
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5450
Mailing Address - Country:US
Mailing Address - Phone:718-499-2169
Mailing Address - Fax:718-499-3218
Practice Address - Street 1:343 4TH AVE
Practice Address - Street 2:AVE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2719
Practice Address - Country:US
Practice Address - Phone:718-499-2169
Practice Address - Fax:718-499-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02183008Medicaid
NY3921590001Medicare NSC
NYW4L982Medicare PIN