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General NPI Number Information
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NPI Number | 1699742304
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Entity Type | Individual
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Provider Name | BARRY FITZHERBERT SLATER PYHSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 2217 W ARNOLD AVE
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City | TRENTON
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State | NJ
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Zip | 08641-5218
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Country | US
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Telephone | 609-754-9624
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Fax |
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Provider Business Mailing Address
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Address Line | 36 PAERDEGAT 5TH ST
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City | BROOKLYN
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State | NY
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Zip | 11236-4138
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Country | US
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Telephone | 718-763-4505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 05641
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00375500
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License Number State | NJ
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