=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649398561
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. LEE ALAN SLOTKIN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1553 STATE HIGHWAY 27 SUITE 3800
-----------------------------------------------------
City | SOMERST
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-247-5959
-----------------------------------------------------
Fax | 732-247-0334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1553 STATE HIGHWAY 27 SUITE 3800
-----------------------------------------------------
City | SOMERST
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-247-5959
-----------------------------------------------------
Fax | 732-247-0334
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DI11891
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------