Provider Demographics
NPI:1669939849
Name:SLISZ, JOHN J (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:SLISZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:5959 BIG TREE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2291
Mailing Address - Country:US
Mailing Address - Phone:716-308-9640
Mailing Address - Fax:862-212-1997
Practice Address - Street 1:5959 BIG TREE RD STE 102
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2291
Practice Address - Country:US
Practice Address - Phone:716-308-9640
Practice Address - Fax:862-212-1997
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY023312363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical