Provider Demographics
NPI:1891954244
Name:SLEVIN, ADAM WILLIAM (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:WILLIAM
Last Name:SLEVIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 E 20TH ST
Mailing Address - Street 2:APT 9G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-1302
Mailing Address - Country:US
Mailing Address - Phone:215-313-8800
Mailing Address - Fax:212-263-0402
Practice Address - Street 1:419 PARK AVE S RM 1305
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8433
Practice Address - Country:US
Practice Address - Phone:212-545-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052844363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY013351OtherSTATE LICENSE
PAMA052844OtherSTATE LICENSE#
PA1073589OtherBOARD CERTIFICATION (NCCPA)#