Provider Demographics
NPI:1396887832
Name:GREGORY J SENGSTOCK MD PA
Entity type:Organization
Organization Name:GREGORY J SENGSTOCK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SENGSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:904-292-4049
Mailing Address - Street 1:14546 OLD SAINT AUGUSTINE RD
Mailing Address - Street 2:STE 301
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5468
Mailing Address - Country:US
Mailing Address - Phone:904-292-4049
Mailing Address - Fax:904-292-4805
Practice Address - Street 1:14546 SAINT AUGUSTINE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5468
Practice Address - Country:US
Practice Address - Phone:904-292-4049
Practice Address - Fax:904-292-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81447174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1033179858OtherNPI
FL70667YMedicare ID - Type Unspecified
FL6105060001Medicare NSC
FL1033179858OtherNPI
FLK5837Medicare ID - Type Unspecified