Provider Demographics
NPI:1740242239
Name:KHUBCHANDANI-STASIK-ROSEN, PC
Entity Type:Organization
Organization Name:KHUBCHANDANI-STASIK-ROSEN, PC
Other - Org Name:KSR, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER, KSR, PC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:STASIK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:610-433-7571
Mailing Address - Street 1:1275 S CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6207
Mailing Address - Country:US
Mailing Address - Phone:610-433-7571
Mailing Address - Fax:610-433-8075
Practice Address - Street 1:1275 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6207
Practice Address - Country:US
Practice Address - Phone:610-433-7571
Practice Address - Fax:610-433-8075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA074510OtherBLUE SHIELD
PA074510Medicare ID - Type Unspecified