Provider Demographics
NPI:1154810133
Name:SLATOFF, JOAN
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:SLATOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BEECHNUT TER
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9611
Mailing Address - Country:US
Mailing Address - Phone:607-273-5776
Mailing Address - Fax:
Practice Address - Street 1:12 BEECHNUT TER
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-9611
Practice Address - Country:US
Practice Address - Phone:607-273-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist