Healthcare Provider Details

I. General information

NPI: 1760565071
Provider Name (Legal Business Name): JON W SLOTOROFF DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 11/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 ANSLEY BLVD SEASHORE MEDICAL ASSOC
PLEASANTVILLE NJ
08232-3058
US

IV. Provider business mailing address

48 ANSLEY BLVD
PLEASANTVILLE NJ
08232-3058
US

V. Phone/Fax

Practice location:
  • Phone: 609-641-1077
  • Fax: 609-641-1023
Mailing address:
  • Phone: 609-641-1077
  • Fax: 609-641-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMB32790
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: