Provider Demographics
NPI:1780650226
Name:SLOTKIN, JAY P (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:P
Last Name:SLOTKIN
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:PO BOX 1437
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-0938
Mailing Address - Country:US
Mailing Address - Phone:631-765-1414
Mailing Address - Fax:631-765-1428
Practice Address - Street 1:50 ACKERLY POND LN
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-3005
Practice Address - Country:US
Practice Address - Phone:631-765-1414
Practice Address - Fax:631-765-1428
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1456881207RG0300X
NY145688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY267AM1OtherEMPIRE BLUE SHIELD
NYP3555349OtherOXFORD
NY10210OtherVYTRA
NY9199852OtherGHI
NY00658966Medicaid
NY9199852OtherGHI
NY51A771Medicare ID - Type Unspecified
A63056Medicare UPIN