Healthcare Provider Details

I. General information

NPI: 1700969771
Provider Name (Legal Business Name): VICTOR S SLOAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PATERSON ST DIVISION OF RHEUMATOLOGY
NEW BRUNSWICK NJ
08901
US

IV. Provider business mailing address

125 PATERSON ST
NEW BRUNSWICK NJ
08901-1962
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-6583
  • Fax: 732-235-6526
Mailing address:
  • Phone: 732-235-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMA61083
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMA60183
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: