Provider Demographics
NPI:1699872234
Name:SLAVICK, HARRIS DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:DAVID
Last Name:SLAVICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 SOUTH MAIN ROAD #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
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA28690208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJJ006377OtherTRICARE ID #
NJ1044982OtherHORIZON NJ HEALTH
NJ222114864OtherHORIZON PROVIDER ID
NJ31D0121012OtherCLIA ID
NJ342921013OtherRAILROAD MEDICARE ID
NJ00071888000OtherAMERIHEALTH PROVIDER ID
NJ222114864OtherFEDERAL TAX ID
NJ2825708Medicaid
NJ222114864OtherFEDERAL TAX ID
NJ342921013OtherRAILROAD MEDICARE ID