Provider Demographics
NPI:1669188934
Name:SLEPIAN, SAMUEL DAVID
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DAVID
Last Name:SLEPIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 LANETT AVE APT B
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5514
Mailing Address - Country:US
Mailing Address - Phone:908-764-6679
Mailing Address - Fax:
Practice Address - Street 1:710 LANETT AVE APT B
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5514
Practice Address - Country:US
Practice Address - Phone:908-764-6679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049642261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy