Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 177709-1 | NY |
N | 204C00000X | Sports Medicine Doctor | MB53521 | NJ |
NPI | 1770578262 |
---|---|
Provider Name | Dr. Barry Sloan |
First Address | New York, NY 10017-9247 |
Second Address | New York, NY 10038-2533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 19/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BS08979210 | BC/BS ID (01) | NY |
BS08979210 | MEDICARE ID NY (01) | NY |
F84436 | (02) | NJ |