Provider Demographics
NPI:1689848145
Name:JEFFREY L STANGER PA
Entity Type:Organization
Organization Name:JEFFREY L STANGER PA
Other - Org Name:SHCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STANGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-498-4300
Mailing Address - Street 1:601 N CONGRESS AVE
Mailing Address - Street 2:SUITE 417
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4703
Mailing Address - Country:US
Mailing Address - Phone:561-272-1582
Mailing Address - Fax:561-272-1932
Practice Address - Street 1:8197 N UNIVERSITY DR STE 3
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1743
Practice Address - Country:US
Practice Address - Phone:954-720-2800
Practice Address - Fax:954-720-6547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3266103G00000X
FLCH3463111N00000X
FLCH8449111N00000X
FLCH8686111N00000X
FLCH9239111N00000X
FLCH8100111N00000X
FLME36462207Q00000X
FLME8830207T00000X
FLME96190207T00000X
FLME80307207XX0801X
FLPT008827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1963OtherMEDICARE GROUP NUMBER