Provider Demographics
NPI:1588761118
Name:CZARNECKI, STANLEY J (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:J
Last Name:CZARNECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1019
Mailing Address - Country:US
Mailing Address - Phone:607-337-4157
Mailing Address - Fax:607-337-4083
Practice Address - Street 1:179 NORTH BROAD STRREET
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1019
Practice Address - Country:US
Practice Address - Phone:607-337-4157
Practice Address - Fax:607-337-4083
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60767207P00000X
NY169803207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0802868000OtherAMERIHEALTH/KEYSTONE/IBC
NJ777941OtherAMERIHEALTH PPO/PA BS
NJ18957OtherUNIVERSITY HEALTH PLAN
NJ60005962OtherHORIZON NJ HEALTH
NJ6883702Medicaid
NJ010006253 00OtherAMERICHOICE
NJ3551717OtherAETNA
NJ3238558OtherCIGNA
NJ2096126OtherUNITED HEALTH CARE
NJP3345593OtherOXFORD
NJ2096126OtherUNITED HEALTH CARE
NJP3345593OtherOXFORD
F66373Medicare UPIN