Provider Demographics
NPI:1699246025
Name:STANKIEWICZ, ROBERTA H (MSG)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:H
Last Name:STANKIEWICZ
Suffix:
Gender:F
Credentials:MSG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 OLD YORK RD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2142
Mailing Address - Country:US
Mailing Address - Phone:267-626-2018
Mailing Address - Fax:866-777-0106
Practice Address - Street 1:501 OLD YORK RD UNIT 4
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2142
Practice Address - Country:US
Practice Address - Phone:267-626-2018
Practice Address - Fax:866-777-0106
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG004101225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist