Provider Demographics
NPI:1689301996
Name:SLAVIN, MORAN (MD)
Entity type:Individual
Prefix:DR
First Name:MORAN
Middle Name:
Last Name:SLAVIN
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 1:1825 EASTCHESTER RD # 2S-3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2301
Mailing Address - Country:US
Mailing Address - Phone:718-904-2829
Mailing Address - Fax:718-904-4183
Practice Address - Street 1:1575 BLONDELL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2660
Practice Address - Country:US
Practice Address - Phone:718-904-2829
Practice Address - Fax:718-904-4183
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332970208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery