Provider Demographics
NPI:1649869892
Name:SLATER, PHILIP A
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:SLATER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 HENDRICKSON DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1701
Mailing Address - Country:US
Mailing Address - Phone:609-751-1864
Mailing Address - Fax:
Practice Address - Street 1:199 HENDRICKSON DR
Practice Address - Street 2:
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1701
Practice Address - Country:US
Practice Address - Phone:609-751-1864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2022-11-25
Deactivation Date:2022-09-12
Deactivation Code:
Reactivation Date:2022-11-15
Provider Licenses
StateLicense IDTaxonomies
AR10162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer