Provider Demographics
NPI:1518476985
Name:PARK SLEEP VIP & WELLNESS LLC
Entity Type:Organization
Organization Name:PARK SLEEP VIP & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOBOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-684-6393
Mailing Address - Street 1:2102 BAY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5945
Mailing Address - Country:US
Mailing Address - Phone:718-684-6393
Mailing Address - Fax:718-684-6395
Practice Address - Street 1:67 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2557
Practice Address - Country:US
Practice Address - Phone:718-684-6393
Practice Address - Fax:718-684-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234613207QS1201X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty