Provider Demographics
NPI:1689726259
Name:PERSONAL CHOICE FAMILY PRACTICE INC.
Entity Type:Organization
Organization Name:PERSONAL CHOICE FAMILY PRACTICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORNE
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:STITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-779-1520
Mailing Address - Street 1:425 GREENWICH CIR
Mailing Address - Street 2:#108
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4807
Mailing Address - Country:US
Mailing Address - Phone:561-779-1520
Mailing Address - Fax:561-691-9624
Practice Address - Street 1:425 GREENWICH CIR
Practice Address - Street 2:#108
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4807
Practice Address - Country:US
Practice Address - Phone:561-779-1520
Practice Address - Fax:561-691-9624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49233OtherBCBS
FLE4677Medicare ID - Type Unspecified
FLH25895Medicare UPIN
FLP00056914Medicare ID - Type UnspecifiedRAIL ROAD