Provider Demographics
NPI:1700866209
Name:STITSKY, LORNE SHANE (DO)
Entity Type:Individual
Prefix:
First Name:LORNE
Middle Name:SHANE
Last Name:STITSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:840 US HIGHWAY ONE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408
Mailing Address - Country:US
Mailing Address - Phone:561-626-9821
Mailing Address - Fax:561-626-7593
Practice Address - Street 1:4601 MILITARY TRL
Practice Address - Street 2:SUITE 209
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4834
Practice Address - Country:US
Practice Address - Phone:561-779-1520
Practice Address - Fax:561-691-9624
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2009-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS0007755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM49233OtherBCBS
H25895Medicare UPIN
FM49233OtherBCBS