Provider Demographics
NPI:1790706760
Name:ALTHEALTH PARK SLOPE LLC
Entity Type:Organization
Organization Name:ALTHEALTH PARK SLOPE LLC
Other - Org Name:ALTHEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:PANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-788-2898
Mailing Address - Street 1:1702 8TH AVE
Mailing Address - Street 2:STE B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1702 8TH AVE
Practice Address - Street 2:STE B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6104
Practice Address - Country:US
Practice Address - Phone:718-788-2898
Practice Address - Fax:718-788-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0276023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3350408OtherOTHER ID NUMBER
3350408OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3350408OtherOTHER ID NUMBER