Provider Demographics
NPI:1992118491
Name:JON STANCIU MEDICAL SERVICES PC
Entity type:Organization
Organization Name:JON STANCIU MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-569-0696
Mailing Address - Street 1:126 GREENPOINT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-2202
Mailing Address - Country:US
Mailing Address - Phone:718-398-0100
Mailing Address - Fax:718-398-9616
Practice Address - Street 1:126 GREENPOINT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-2202
Practice Address - Country:US
Practice Address - Phone:718-398-0100
Practice Address - Fax:718-398-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100112389Medicare PIN