Provider Demographics
NPI:1104006717
Name:ALFRED E. SLONIM PHYSICIAN PC
Entity Type:Organization
Organization Name:ALFRED E. SLONIM PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:SLONIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-616-0074
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:SUITE N210
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1011
Mailing Address - Country:US
Mailing Address - Phone:516-616-0074
Mailing Address - Fax:516-616-9388
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:SUITE N210
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1011
Practice Address - Country:US
Practice Address - Phone:516-616-0074
Practice Address - Fax:516-616-9388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1574591207SM0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SM0001XAllopathic & Osteopathic PhysiciansMedical GeneticsMolecular Genetic PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01156725Medicaid
NY01156725Medicaid
NY31D291Medicare PIN