Healthcare Provider Details

I. General information

NPI: 1871839035
Provider Name (Legal Business Name): NIKOLE L SLOWICK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKOLE L DELAIR

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PARK ST CR WOOD CANCER CENTER
GLENS FALLS NY
12801
US

IV. Provider business mailing address

100 PARK ST
GLENS FALLS NY
12801-4447
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-6620
  • Fax:
Mailing address:
  • Phone: 518-926-5924
  • Fax: 518-926-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number016081
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: