Basic Information
| Provider Information | |||||||||
| NPI: | 1174708994 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ERIC STELNICKI MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 SE 15TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333013908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549831899 | ||||||||
| FaxNumber: | 9543183215 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 SE 15TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333013908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549831899 | ||||||||
| FaxNumber: | 9543183215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2007 | ||||||||
| LastUpdateDate: | 01/25/2017 | ||||||||
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| AuthorizedOfficialLastName: | STELNICKI | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9549831899 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.