Provider Demographics
NPI:1710105028
Name:PANCZAK, STEPHEN PETER (RNDT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:PETER
Last Name:PANCZAK
Suffix:
Gender:M
Credentials:RNDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 BELL LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6511
Mailing Address - Country:US
Mailing Address - Phone:561-627-2210
Mailing Address - Fax:561-627-5850
Practice Address - Street 1:1852 BELL LN
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6511
Practice Address - Country:US
Practice Address - Phone:561-627-2210
Practice Address - Fax:561-627-5850
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic