Healthcare Provider Details

I. General information

NPI: 1689102121
Provider Name (Legal Business Name): JOSEPHINE ANDREA SLIFKA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9005 OLD RIVER RD
MARCY NY
13403-3000
US

IV. Provider business mailing address

9005 OLD RIVER RD
MARCY NY
13403-3000
US

V. Phone/Fax

Practice location:
  • Phone: 315-765-3600
  • Fax:
Mailing address:
  • Phone: 315-765-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341773
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: