Individual
MS. ANNELISE PAIGE SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 PORT WASHINGTON BLVD, ROSLYN, NY 11576-1353
(516) 562-6000
Mailing address
65 BELMONT AVE, WEST BABYLON, NY 11704-6435
(631) 338-8379
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
09/09/2021
Last updated
09/09/2021
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