East End Geriatric & Adult Medicine PLLC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

Legal business name

EAST END GERIATRIC & ADULT MEDICINE PLLC

Practice address

50 Ackerly Pond Lane
Southold, NY 11971-3005

Phone

(631) 765-1414

Fax

(631) 765-1428

NPI assigned

Feb 24, 2006

Last updated

Jul 3, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jay P Slotkin, MDNPI 1780650226

Title

President

Phone

(631) 765-1414

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Professional Limited Liability Corp. Other name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jay P Slotkin, MD

  • Internal Medicine Physician
  • Southold, NY
  • NPI 1780650226

  Geriatric Medicine

  Medicare reassignment NPD Authorized official
• Taylor Rae Madlinger, PA

  • Physician Assistant
  • Manorville, NY
  • NPI 1811770233
  Medicare reassignment
• Eileen Mellor Siciliano, L.C.S.W.

  • Clinical Social Worker
  • Southold, NY
  • NPI 1013977057
  NPD
• Judith Alicia Rose, LCSW

  • Clinical Social Worker
  • East Quogue, NY
  • NPI 1467653097
  NPD (past)
• Robert Dupre Walsh, MD

  • Infectious Disease Physician
  • Bronx, NY
  • NPI 1942250576
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341273600000",
    "number": "1851367304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1437",
            "city": "SOUTHOLD",
            "state": "NY",
            "postal_code": "119710938",
            "telephone_number": "631-765-1414",
            "fax_number": "631-765-1428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 ACKERLY POND LANE",
            "city": "SOUTHOLD",
            "state": "NY",
            "postal_code": "119713005",
            "telephone_number": "631-765-1414",
            "fax_number": "631-765-1428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST END GERIATRIC & ADULT MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-24",
        "last_updated": "2012-07-03",
        "status": "A",
        "authorized_official_last_name": "SLOTKIN",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-765-1414",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "23013867",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "DD8034",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02632497",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Limited Liability Corp.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Justin Christopher Didonato, DPT
• Christopher John Digregorio, RN
• Joan Marie Doherty, R.N.
• Wendy M Dolan, RN
• Ariel Caitlin Dorfmeister Rojas, LMT
• East End Home Care Inc
• East End Physician Services PC
• Eastern Suffolk Spine and Pain Medicine, PLLC
• Eastern Sun Acupuncture
• Lester Eisenberg, RPH

• Geriatric Medicine (Internal Medicine) Physician in Southold, NY
• Providers in Southold, NY by specialty
• Geriatric Medicine (Internal Medicine) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.