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General NPI Number Information
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NPI Number | 1851367304
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Entity Type | Organization
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Legal Business Name | EAST END GERIATRIC & ADULT MEDICINE PLLC
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 07/03/2012
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Provider Practice Location Address
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Address Line | 50 ACKERLY POND LANE
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City | SOUTHOLD
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State | NY
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Zip | 11971-3005
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Country | US
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Telephone | 631-765-1414
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Fax | 631-765-1428
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Provider Business Mailing Address
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Address Line | PO BOX 1437
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City | SOUTHOLD
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State | NY
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Zip | 11971-0938
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Country | US
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Telephone | 631-765-1414
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Fax | 631-765-1428
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY P SLOTKIN
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Credential | MD
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Telephone | 631-765-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 23013867
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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