Healthcare Provider Details

I. General information

NPI: 1134185846
Provider Name (Legal Business Name): GUS JAY SLOTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1765 SPRINGDALE RD SUITE B1
CHERRY HILL NJ
08003-2177
US

IV. Provider business mailing address

500 GROVE ST SUITE 100
HADDON HEIGHTS NJ
08035-1702
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-1110
  • Fax: 856-424-3113
Mailing address:
  • Phone: 956-796-9200
  • Fax: 856-310-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMA03203600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMA03203600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: