Provider Demographics
NPI:1841676293
Name:SAMANTHA SLOTNICK, INC
Entity type:Organization
Organization Name:SAMANTHA SLOTNICK, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOTNICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FAAO, FCOVD
Authorized Official - Phone:914-874-1118
Mailing Address - Street 1:495 CENTRAL PARK AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1038
Mailing Address - Country:US
Mailing Address - Phone:914-874-1177
Mailing Address - Fax:914-885-1463
Practice Address - Street 1:495 CENTRAL PARK AVE STE 301
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1038
Practice Address - Country:US
Practice Address - Phone:914-874-1177
Practice Address - Fax:914-885-1463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006820152W00000X, 152WL0500X, 152WP0200X, 152WX0102X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300083922OtherMEDICARE PTAN-PROVIDER TRANSACTION ACCESS NUMBER
NYA300083922OtherMEDICARE PTAN-PROVIDER TRANSACTION ACCESS NUMBER