Provider Demographics
NPI:1386061133
Name:SLAVUTIN, LEE J (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:J
Last Name:SLAVUTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LEON
Other - Middle Name:J
Other - Last Name:SLAVUTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 RIVERSIDE DRIVE
Mailing Address - Street 2:APT 15D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-496-8018
Mailing Address - Fax:646-224-9887
Practice Address - Street 1:100 RIVERSIDE DRIVE
Practice Address - Street 2:APT 15D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-496-8018
Practice Address - Fax:646-224-9887
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140754-1207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology