Provider Demographics
NPI:1699742304
Name:SLATER, BARRY FITZHERBERT (PYHSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:FITZHERBERT
Last Name:SLATER
Suffix:
Gender:M
Credentials:PYHSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:36 PAERDEGAT 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4138
Mailing Address - Country:US
Mailing Address - Phone:718-763-4505
Mailing Address - Fax:
Practice Address - Street 1:2217 W ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08641-5218
Practice Address - Country:US
Practice Address - Phone:609-754-9624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05641363A00000X
NJ25MP00375500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant