Provider Demographics
NPI:1811361025
Name:PARK SLOPE DIAGNOSTIC BROOKLYN INC
Entity Type:Organization
Organization Name:PARK SLOPE DIAGNOSTIC BROOKLYN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-633-3505
Mailing Address - Street 1:1243 60TH ST # 1RR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1243 60TH ST # 1RR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4930
Practice Address - Country:US
Practice Address - Phone:347-633-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-26
Last Update Date:2015-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213ER0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Multi-Specialty