Provider Demographics
NPI:1598342412
Name:GITELMAN, SLAVIC (DO)
Entity Type:Individual
Prefix:
First Name:SLAVIC
Middle Name:
Last Name:GITELMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:SLAVA
Other - Middle Name:
Other - Last Name:GITELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1580 E 13TH ST APT 6D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7138
Mailing Address - Country:US
Mailing Address - Phone:347-278-2431
Mailing Address - Fax:
Practice Address - Street 1:7600 RIVER RD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-6217
Practice Address - Country:US
Practice Address - Phone:347-278-2431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program