Provider Demographics
NPI:1326071242
Name:STOLARCZYK, HALINA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:HALINA
Middle Name:MARIA
Last Name:STOLARCZYK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 TITUS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-4140
Mailing Address - Country:US
Mailing Address - Phone:585-544-5450
Mailing Address - Fax:585-544-5752
Practice Address - Street 1:1151 TITUS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-4140
Practice Address - Country:US
Practice Address - Phone:585-544-5450
Practice Address - Fax:585-544-5752
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01616820Medicaid
NYMDF351OtherPREFERRED CARE PROVIDER
NY010200724OtherEXCELLUS BC/BS ROCHESTER
NYMDF351OtherPREFERRED CARE PROVIDER
NY01616820Medicaid