1750357307 NPI number — MR. JAN SLEZAK MD

Table of content: MR. JAN SLEZAK MD (NPI 1750357307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750357307 NPI number — MR. JAN SLEZAK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLEZAK
Provider First Name:
JAN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750357307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
944 CALEF HWY
Provider Second Line Business Mailing Address:
INTERVENTIONAL SPINE MEDICINE
Provider Business Mailing Address City Name:
BARRINGTON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03825-7244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-664-0100
Provider Business Mailing Address Fax Number:
603-664-0101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
944 CALEF HWY
Provider Second Line Business Practice Location Address:
INTERVENTIONAL SPINE MEDICINE
Provider Business Practice Location Address City Name:
BARRINGTON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03825-7244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-664-0100
Provider Business Practice Location Address Fax Number:
603-664-0101
Provider Enumeration Date:
02/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  10063 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0100701Y0NH01 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 279615 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30010746 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 277182 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 5005131 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AZ7610 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".




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