Provider Demographics
NPI:1750357307
Name:SLEZAK, JAN (MD)
Entity type:Individual
Prefix:MR
First Name:JAN
Middle Name:
Last Name:SLEZAK
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 1:944 CALEF HWY
Mailing Address - Street 2:INTERVENTIONAL SPINE MEDICINE
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825-7244
Mailing Address - Country:US
Mailing Address - Phone:603-664-0100
Mailing Address - Fax:603-664-0101
Practice Address - Street 1:944 CALEF HWY
Practice Address - Street 2:INTERVENTIONAL SPINE MEDICINE
Practice Address - City:BARRINGTON
Practice Address - State:NH
Practice Address - Zip Code:03825-7244
Practice Address - Country:US
Practice Address - Phone:603-664-0100
Practice Address - Fax:603-664-0101
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10063208VP0014X, 174400000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0100701Y0NH01OtherANTHEM
NH279615OtherCIGNA
NH30010746Medicaid
NH277182OtherHARVARD PILGRIM
5005131OtherRAILROAD MEDICARE
AZ7610OtherMEDICARE
NHRE4594Medicare ID - Type Unspecified
NH279615OtherCIGNA
NH0100701Y0NH01OtherANTHEM
NH277182OtherHARVARD PILGRIM