Provider Demographics
NPI:1659666808
Name:SLENTZ SURGICAL LLC
Entity Type:Organization
Organization Name:SLENTZ SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SLENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-368-8100
Mailing Address - Street 1:319 W CALL ST
Mailing Address - Street 2:BLDG B STE A
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-3113
Mailing Address - Country:US
Mailing Address - Phone:908-368-8100
Mailing Address - Fax:908-368-8120
Practice Address - Street 1:319 W CALL ST
Practice Address - Street 2:BLDG B STE A
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-3113
Practice Address - Country:US
Practice Address - Phone:908-368-8100
Practice Address - Fax:908-368-8120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty