Active NPI
Johnny Slade, MD
- Emergency Medicine Physician
- East Setauket, NY
National Provider Identifier
1295392553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 176120
- Practice address
- 11 Bridge Rd
East Setauket, NY 11733 - Phone
- (631) 476-4000
- Fax
- (631) 476-4003
- NPI assigned
- May 22, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 176120 | NY | Primary |
Addresses
Primary practice location
11 Bridge Rd
East Setauket, NY 11733
Mailing address
11 Bridge Rd
East Setauket, NY 11733
Phone (631) 476-4000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 176120 | NY | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558483200000",
"number": "1295392553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 BRIDGE RD",
"city": "EAST SETAUKET",
"state": "NY",
"postal_code": "11733",
"telephone_number": "631-476-4000",
"fax_number": "631-476-4003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 BRIDGE RD",
"city": "EAST SETAUKET",
"state": "NY",
"postal_code": "11733",
"telephone_number": "631-476-4000",
"fax_number": "631-476-4003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SLADE",
"first_name": "JOHNNY",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-05-22",
"last_updated": "2019-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NY",
"license": "176120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Setauket, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.