Provider Demographics
NPI:1013140789
Name:EX LS MEDICAL PC
Entity Type:Organization
Organization Name:EX LS MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:LYUDMILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SLUPSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-615-9000
Mailing Address - Street 1:2626 E 14TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3977
Mailing Address - Country:US
Mailing Address - Phone:718-615-9000
Mailing Address - Fax:
Practice Address - Street 1:2626 E 14TH ST STE 207
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3977
Practice Address - Country:US
Practice Address - Phone:718-615-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty