MEDICARE: DR. MICHAEL SLATTERY M.D.

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	2085R0202X	Diagnostic Radiology Physician	151527	NY

General Provider Information

NPI Number	:	1942283767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SLATTERY M.D.

Provider Business Mailing Address
First Line	:	52 MAIN ST
Second Line	:
City	:	BEDFORD HILLS
State	:	NY
Zip	:	10507-1814
Country	:	US
Telephone Number	:	914-666-2220
Fax Number	:	914-666-2987

Provider Business Practice Location Address
First Line	:	285 SILLS RD BLDG 18
Second Line	:	RADIOLOGY DEPARTMENT
City	:	EAST PATCHOGUE
State	:	NY
Zip	:	11772-4808
Country	:	US
Telephone Number	:	952-595-1100
Fax Number	:	612-294-4903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	03/24/2016

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