Provider Demographics
NPI:1841240132
Name:WASILEWSKI, STAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STAN
Middle Name:J
Last Name:WASILEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MAY ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3266
Mailing Address - Country:US
Mailing Address - Phone:732-738-8855
Mailing Address - Fax:738-738-4141
Practice Address - Street 1:225 MAY ST
Practice Address - Street 2:SUITE F
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3266
Practice Address - Country:US
Practice Address - Phone:732-738-8855
Practice Address - Fax:738-738-4141
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06116300207RC0000X, 207RC0001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6814603Medicaid
NJ6814603Medicaid