Provider Demographics
NPI:1790846731
Name:GORDON SLIS, VIKKI (PHD)
Entity Type:Individual
Prefix:MS
First Name:VIKKI
Middle Name:
Last Name:GORDON SLIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2518
Mailing Address - Country:US
Mailing Address - Phone:631-884-1503
Mailing Address - Fax:631-738-8039
Practice Address - Street 1:291 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2518
Practice Address - Country:US
Practice Address - Phone:631-884-1503
Practice Address - Fax:631-738-8039
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0051451103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY099830OtherVALUE OPTIONS
NY005145OtherHIP
NYP370311OtherOXFORD
NY0028790OtherGHI
NYV11911Medicare UPIN