Doctor Name: | DR. STANLEY MICHAEL STANISH |
NPI Number: | 1033257407 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MD039841-L |
Business Practice Address: | 675 Wyoming Ave Kingston, PA - 187043831 |
Business Phone Number: | 5702884205 |
Business Fax Number: | |
Mailing Address: | 675 Wyoming Ave, KINGSTON |
State: | PA |
Postal Code: | 187043831 |
Phone Number: | 5702884205 |
Fax Number: | |
NPI Enumeration Date: | 02/01/2007 |
NPI Last Update Date: | 09/17/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MD039841-L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |