Provider Demographics
NPI:1619370731
Name:NEW STARTS
Entity Type:Organization
Organization Name:NEW STARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SLABIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-459-0585
Mailing Address - Street 1:2409 STATE ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16503-1856
Mailing Address - Country:US
Mailing Address - Phone:814-459-0585
Mailing Address - Fax:
Practice Address - Street 1:2409 STATE ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16503-1856
Practice Address - Country:US
Practice Address - Phone:814-459-0585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032321E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026334450001Medicaid
PA117695Medicare PIN
PAB37055Medicare UPIN