Provider Demographics
NPI:1902017965
Name:SLOTNICK, SAMANTHA (OD, FAAO, FCOVD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:SLOTNICK
Suffix:
Gender:F
Credentials:OD, FAAO, FCOVD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 OLD MAMARONECK RD APT 4L
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2013
Mailing Address - Country:US
Mailing Address - Phone:914-874-1118
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:914-874-1118
Practice Address - Fax:914-885-1463
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00597800152W00000X
NYTUV006820152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
A300083922OtherMEDICARE PTAN- PROVIDER TRANSACTION ACCESS NUMBER
NYV04305Medicare UPIN
NYC377G1Medicare ID - Type UnspecifiedMEDICARE PROVIDER #