Individual
JOHNNY SLADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11 BRIDGE RD, EAST SETAUKET, NY 11733
(631) 476-4000
(631) 476-4003
Mailing address
11 BRIDGE RD, EAST SETAUKET, NY 11733
(631) 476-4000
(631) 476-4003
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
176120
NY
Other
Enumeration date
05/22/2019
Last updated
05/22/2019
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