Provider Demographics
NPI:1396048492
Name:HARRIS D SLAVICK MD PA
Entity type:Organization
Organization Name:HARRIS D SLAVICK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:SLAVICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-691-2225
Mailing Address - Street 1:1317 S MAIN RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6511
Mailing Address - Country:US
Mailing Address - Phone:856-691-2225
Mailing Address - Fax:856-696-6992
Practice Address - Street 1:1317 S MAIN RD STE 2A
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6511
Practice Address - Country:US
Practice Address - Phone:856-691-2225
Practice Address - Fax:856-696-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA28690208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2825708Medicaid
NJC52575Medicare UPIN
NJ2825708Medicaid