Provider Demographics
NPI:1174158729
Name:SLEPIAN, PHILIP
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:SLEPIAN
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 1:1783 COLVIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1107
Mailing Address - Country:US
Mailing Address - Phone:716-874-2150
Mailing Address - Fax:
Practice Address - Street 1:1783 COLVIN BLVD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1107
Practice Address - Country:US
Practice Address - Phone:716-874-2150
Practice Address - Fax:716-874-6765
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024796363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical