Provider Demographics
NPI:1346775608
Name:JASICKI, STANTON (DO)
Entity Type:Individual
Prefix:DR
First Name:STANTON
Middle Name:
Last Name:JASICKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 20TH ST
Mailing Address - Street 2:APT. 3R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-1182
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:146 20TH ST
Practice Address - Street 2:APT. 3R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-1182
Practice Address - Country:US
Practice Address - Phone:715-642-1751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A18673207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine