Provider Demographics
NPI:1669686945
Name:STEFANOSKI, GERALD PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:PETER
Last Name:STEFANOSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18706-3350
Mailing Address - Country:US
Mailing Address - Phone:570-823-7070
Mailing Address - Fax:570-823-0805
Practice Address - Street 1:87 OXFORD ST
Practice Address - Street 2:
Practice Address - City:HANOVER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18706-3350
Practice Address - Country:US
Practice Address - Phone:570-823-7070
Practice Address - Fax:570-823-0805
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003174-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010390730002Medicaid
PA0010390730002Medicaid
PAT30577Medicare UPIN