Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MA03203600 | NJ |
Y | 208600000X | Surgeon | MA03203600 | NJ |
N | 2086S0102X | Surgical Critical Care | MA03203600 | NJ |
NPI | 1134185846 |
---|---|
Provider Name | Dr. Gus Jay Slotman |
First Address | Haddon Heights, NJ 08035-1702 |
Second Address | Cherry Hill, NJ 08003-2177 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 21/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3763806 | (05) | NJ |
E55108 | (02) | NJ |