Healthcare Provider Details

I. General information

NPI: 1538154240
Provider Name (Legal Business Name): LAURIE MOIK SLOTNICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

11 HOSPITAL HILL RD
SHARON CT
06069-2010
US

IV. Provider business mailing address

PO BOX 337 11 HOSPITAL HILL RD
SHARON CT
06069-0337
US

V. Phone/Fax

Practice location:
  • Phone: 860-364-2098
  • Fax: 860-364-5757
Mailing address:
  • Phone: 860-364-2098
  • Fax: 860-364-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number030007
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: