Provider Demographics
NPI:1689658007
Name:SLOMBA, JAN M (MD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:M
Last Name:SLOMBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 OVINGTON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1483
Mailing Address - Country:US
Mailing Address - Phone:718-759-0108
Mailing Address - Fax:718-759-0109
Practice Address - Street 1:355 OVINGTON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1483
Practice Address - Country:US
Practice Address - Phone:718-759-0108
Practice Address - Fax:718-759-0109
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY228292207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02431652Medicaid
NY94S761Medicare PIN
NY02431652Medicaid