MEDICARE: EAST END GERIATRIC & ADULT MEDICINE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner
2	363AM0700X	Medical Physician Assistant	23013867	NY
3	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD8034	OTHER	NY	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851367304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST END GERIATRIC & ADULT MEDICINE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1437
Second Line	:
City	:	SOUTHOLD
State	:	NY
Zip	:	11971-0938
Country	:	US
Telephone Number	:	631-765-1414
Fax Number	:	631-765-1428

Provider Business Practice Location Address
First Line	:	50 ACKERLY POND LANE
Second Line	:
City	:	SOUTHOLD
State	:	NY
Zip	:	11971-3005
Country	:	US
Telephone Number	:	631-765-1414
Fax Number	:	631-765-1428

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAY P SLOTKIN
Credential	:	MD
Telephone Number	:	631-765-1414

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	07/03/2012

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Directions to “EAST END GERIATRIC & ADULT MEDICINE PLLC ” Practice Location

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