Provider Demographics
NPI:1144236746
Name:PARK SLOPE MEDICAL SERVICE PC
Entity Type:Organization
Organization Name:PARK SLOPE MEDICAL SERVICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-780-5664
Mailing Address - Street 1:1900 HEMPSTEAD TURNPIKE SUITE 500
Mailing Address - Street 2:
Mailing Address - City:EAST MEADON
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:516-542-1090
Mailing Address - Fax:516-794-8165
Practice Address - Street 1:506 SIXTH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-780-5664
Practice Address - Fax:718-761-7037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01001789Medicaid
NY01001789Medicaid