MEDICARE: ELENA SLATER, M.D., LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1952435372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELENA SLATER, M.D., LLC

Provider Business Mailing Address
First Line	:	30 SKYLINE DR
Second Line	:
City	:	UPPER SADDLE RIVER
State	:	NJ
Zip	:	07458-2028
Country	:	US
Telephone Number	:	201-825-7596
Fax Number	:

Provider Business Practice Location Address
First Line	:	735 LINWOOD AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3534
Country	:	US
Telephone Number	:	201-670-1231
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ELENA G. SLATER
Credential	:	M.D.
Telephone Number	:	201-825-7596

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	02/04/2009

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