Healthcare Provider Details

I. General information

NPI: 1841676293
Provider Name (Legal Business Name): SAMANTHA SLOTNICK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2015
Last Update Date: 08/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 CENTRAL PARK AVE STE 301
SCARSDALE NY
10583-1038
US

IV. Provider business mailing address

495 CENTRAL PARK AVE STE 301
SCARSDALE NY
10583-1038
US

V. Phone/Fax

Practice location:
  • Phone: 914-874-1177
  • Fax: 914-885-1463
Mailing address:
  • Phone: 914-874-1177
  • Fax: 914-885-1463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006820
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberTUV006820
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberTUV006820
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberTUV006820
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberTUV006820
License Number StateNY

VIII. Authorized Official

Name: DR. SAMANTHA SLOTNICK
Title or Position: OPTOMETRIST, OWNER
Credential: OD, FAAO, FCOVD
Phone: 914-874-1118