Healthcare Provider Details

I. General information

NPI: 1104006717
Provider Name (Legal Business Name): ALFRED E. SLONIM PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MARCUS AVE SUITE N210
NEW HYDE PARK NY
11042-1011
US

IV. Provider business mailing address

2001 MARCUS AVE SUITE N210
NEW HYDE PARK NY
11042-1011
US

V. Phone/Fax

Practice location:
  • Phone: 516-616-0074
  • Fax: 516-616-9388
Mailing address:
  • Phone: 516-616-0074
  • Fax: 516-616-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SM0001X
TaxonomyMolecular Genetic Pathology (Medical Genetics) Physician
License Number1574591
License Number StateNY

VIII. Authorized Official

Name: DR. ALFRED E. SLONIM
Title or Position: DIRECTOR
Credential:
Phone: 516-616-0074