Healthcare Provider Details

I. General information

NPI: 1104655331
Provider Name (Legal Business Name): DAVID SLAWASKA-ENG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date: 05/13/2025
Reactivation Date: 08/27/2025

III. Provider practice location address

22567 SUMMIT DR BLDG 2
WATERTOWN NY
13601-7210
US

IV. Provider business mailing address

27454 COUNTY ROUTE 57
THREE MILE BAY NY
13693
US

V. Phone/Fax

Practice location:
  • Phone: 315-779-6784
  • Fax:
Mailing address:
  • Phone: 514-887-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number340014
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number340014
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: