Provider Demographics
NPI:1407009848
Name:SLOVAK, MARY JEANINE (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JEANINE
Last Name:SLOVAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:FINORA
Other - Last Name:SLOVAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:205 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:NY
Mailing Address - Zip Code:11948-1628
Mailing Address - Country:US
Mailing Address - Phone:631-298-4272
Mailing Address - Fax:631-298-4272
Practice Address - Street 1:205 7TH ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:NY
Practice Address - Zip Code:11948-1628
Practice Address - Country:US
Practice Address - Phone:631-298-4272
Practice Address - Fax:631-298-4272
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010865-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics