Provider Demographics
NPI:1659798189
Name:SLATKO, GARY HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:HOWARD
Last Name:SLATKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 RECTOR PL
Mailing Address - Street 2:UNIT 11N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1116
Mailing Address - Country:US
Mailing Address - Phone:610-766-1222
Mailing Address - Fax:
Practice Address - Street 1:225 RECTOR PL
Practice Address - Street 2:UNIT 11N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280-1116
Practice Address - Country:US
Practice Address - Phone:610-766-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031241E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine