Basic Information
| Provider Information | |||||||||
| NPI: | 1134185846 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLOTMAN | ||||||||
| FirstName: | GUS | ||||||||
| MiddleName: | JAY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 GROVE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HADDON HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080351702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567969200 | ||||||||
| FaxNumber: | 8563105603 | ||||||||
| Practice Location | |||||||||
| Address1: | 1765 SPRINGDALE RD | ||||||||
| Address2: | SUITE B1 | ||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080032177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564241110 | ||||||||
| FaxNumber: | 8564243113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 01/21/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MA03203600 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | MA03203600 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 3763806 | 05 | NJ | MEDICAID |