Provider Demographics
NPI:1811998610
Name:SLADE, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:SLADE
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 1:4-14 SADDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5632
Mailing Address - Country:US
Mailing Address - Phone:201-791-4002
Mailing Address - Fax:201-791-7040
Practice Address - Street 1:4-14 SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5632
Practice Address - Country:US
Practice Address - Phone:201-791-4002
Practice Address - Fax:201-791-7040
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32657208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1008706Medicaid
NJC60858Medicare UPIN
NJ1008706Medicaid