Provider Demographics
NPI:1609517127
Name:SLIVONIK, BRIAN WALLACE
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:WALLACE
Last Name:SLIVONIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 HOFFMAN ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1605
Mailing Address - Country:US
Mailing Address - Phone:607-442-1713
Mailing Address - Fax:
Practice Address - Street 1:1001 HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1605
Practice Address - Country:US
Practice Address - Phone:607-442-1713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program