Provider Demographics
NPI:1275709776
Name:SLATER, JILL RORY (NP)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:RORY
Last Name:SLATER
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1320 YORK AVE
Mailing Address - Street 2:12N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4800
Mailing Address - Country:US
Mailing Address - Phone:917-880-1317
Mailing Address - Fax:718-635-7223
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2916
Practice Address - Country:US
Practice Address - Phone:718-283-6000
Practice Address - Fax:718-635-7223
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY304685363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health