Healthcare Provider Details

I. General information

NPI: 1336026897
Provider Name (Legal Business Name): GREGORY PETER SLONIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1358 56TH ST
BROOKLYN NY
11219-4616
US

IV. Provider business mailing address

1358 56TH ST
BROOKLYN NY
11219-4616
US

V. Phone/Fax

Practice location:
  • Phone: 718-851-7100
  • Fax:
Mailing address:
  • Phone: 718-851-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number823079
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number823079
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: