Provider Demographics
NPI:1134185846
Name:SLOTMAN, GUS JAY (MD)
Entity type:Individual
Prefix:DR
First Name:GUS
Middle Name:JAY
Last Name:SLOTMAN
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 1:500 GROVE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1702
Mailing Address - Country:US
Mailing Address - Phone:956-796-9200
Mailing Address - Fax:856-310-5603
Practice Address - Street 1:1765 SPRINGDALE RD
Practice Address - Street 2:SUITE B1
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2177
Practice Address - Country:US
Practice Address - Phone:856-424-1110
Practice Address - Fax:856-424-3113
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA03203600208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3763806Medicaid
613039C04Medicare ID - Type Unspecified
NJE55108Medicare UPIN