Healthcare Provider Details

I. General information

NPI: 1346439973
Provider Name (Legal Business Name): AVA SLATKIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 GALLOPING HILL RD K-16 EMPLOYEE HEALTH SERVICES
KENILWORTH NJ
07033-1310
US

IV. Provider business mailing address

8 CRESTHILL RD
VERONA NJ
07044-1313
US

V. Phone/Fax

Practice location:
  • Phone: 908-298-2818
  • Fax: 908-298-2834
Mailing address:
  • Phone: 973-857-1816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License NumberMA43254
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: