Provider Demographics
NPI:1689634834
Name:STENCLIK, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:STENCLIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 CHILI AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-3425
Mailing Address - Country:US
Mailing Address - Phone:585-247-0070
Mailing Address - Fax:585-247-0075
Practice Address - Street 1:2115 CHILI AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-3425
Practice Address - Country:US
Practice Address - Phone:585-247-0070
Practice Address - Fax:585-247-0075
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169354-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01004746Medicaid
NYJ400145909/GRP70008AMedicare PIN
NYJ400145907/GRPBA0017Medicare PIN
NY01004746Medicaid