Provider Demographics
NPI:1891259560
Name:PARK SLOPE INTEGRATIVE MEDICINE PLCC
Entity Type:Organization
Organization Name:PARK SLOPE INTEGRATIVE MEDICINE PLCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:NAYANKUMAR
Authorized Official - Last Name:CHINIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-276-3155
Mailing Address - Street 1:230A 6TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1396
Mailing Address - Country:US
Mailing Address - Phone:917-596-9678
Mailing Address - Fax:
Practice Address - Street 1:278 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3906
Practice Address - Country:US
Practice Address - Phone:845-276-3155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty