Provider Demographics
NPI:1346439973
Name:SLATKIN, AVA (MD)
Entity Type:Individual
Prefix:DR
First Name:AVA
Middle Name:
Last Name:SLATKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CRESTHILL RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1313
Mailing Address - Country:US
Mailing Address - Phone:973-857-1816
Mailing Address - Fax:
Practice Address - Street 1:2000 GALLOPING HILL RD
Practice Address - Street 2:K-16 EMPLOYEE HEALTH SERVICES
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1310
Practice Address - Country:US
Practice Address - Phone:908-298-2818
Practice Address - Fax:908-298-2834
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA43254261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health