Provider Demographics
NPI:1174708994
Name:ERIC STELNICKI MD PA
Entity type:Organization
Organization Name:ERIC STELNICKI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:STELNICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-983-1899
Mailing Address - Street 1:100 SE 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3908
Mailing Address - Country:US
Mailing Address - Phone:954-983-1899
Mailing Address - Fax:954-318-3215
Practice Address - Street 1:100 SE 15TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3908
Practice Address - Country:US
Practice Address - Phone:954-983-1899
Practice Address - Fax:954-318-3215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44806Medicare PIN