Healthcare Provider Details

I. General information

NPI: 1134188402
Provider Name (Legal Business Name): STUART F. SLAVIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 CEDAR HILL AVE
WYCKOFF NJ
07481-2150
US

IV. Provider business mailing address

11 BROOK HOLLOW RD
OAKLAND NJ
07436-3404
US

V. Phone/Fax

Practice location:
  • Phone: 201-652-0300
  • Fax:
Mailing address:
  • Phone: 201-651-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA068747
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: