Provider Demographics
NPI:1538154240
Name:SLOTNICK, LAURIE MOIK (MD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:MOIK
Last Name:SLOTNICK
Suffix:
Gender:F
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:PO BOX 337
Mailing Address - Street 2:11 HOSPITAL HILL RD
Mailing Address - City:SHARON
Mailing Address - State:CT
Mailing Address - Zip Code:06069-0337
Mailing Address - Country:US
Mailing Address - Phone:860-364-2098
Mailing Address - Fax:860-364-5757
Practice Address - Street 1:11 HOSPITAL HILL RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069-2010
Practice Address - Country:US
Practice Address - Phone:860-364-2098
Practice Address - Fax:860-364-5757
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
CT030007174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE39335Medicare UPIN