Provider Demographics
NPI:1871545566
Name:PARK SLOPE MEDICAL OFFICE PC
Entity type:Organization
Organization Name:PARK SLOPE MEDICAL OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-832-1964
Mailing Address - Street 1:9322 3RD AVE
Mailing Address - Street 2:STE 504
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6802
Mailing Address - Country:US
Mailing Address - Phone:718-832-1964
Mailing Address - Fax:718-832-0526
Practice Address - Street 1:3443 83RD ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3054
Practice Address - Country:US
Practice Address - Phone:718-832-1964
Practice Address - Fax:718-832-0526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01816875Medicaid
NYE44733Medicare UPIN
NY01816875Medicaid