Provider Demographics
NPI:1760565071
Name:SLOTOROFF, JON W (DO)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:W
Last Name:SLOTOROFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 ANSLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-3058
Mailing Address - Country:US
Mailing Address - Phone:609-641-1077
Mailing Address - Fax:609-641-1023
Practice Address - Street 1:48 ANSLEY BLVD
Practice Address - Street 2:SEASHORE MEDICAL ASSOC
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-3058
Practice Address - Country:US
Practice Address - Phone:609-641-1077
Practice Address - Fax:609-641-1023
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB32790207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1818902Medicaid
C57333Medicare UPIN
NJ113936ANGMedicare ID - Type Unspecified