Provider Demographics
NPI:1013018324
Name:PARK SLOPE PHYSICIAN SERVICES PC
Entity Type:Organization
Organization Name:PARK SLOPE PHYSICIAN SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-780-3031
Mailing Address - Street 1:PO BOX 5451
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5451
Mailing Address - Country:US
Mailing Address - Phone:717-625-3999
Mailing Address - Fax:717-625-3986
Practice Address - Street 1:1309 AVENUE J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3605
Practice Address - Country:US
Practice Address - Phone:718-677-1710
Practice Address - Fax:718-677-6586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01916229Medicaid
W35571Medicare PIN
W35533Medicare PIN
W35531Medicare PIN
W35532Medicare PIN
W0Z791Medicare PIN
W0Z793Medicare PIN