Provider Demographics
NPI:1861472227
Name:STASIK, JOHN J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:STASIK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
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:610-433-8798
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:610-433-8798
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD011876E208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007349920001Medicaid
168455Medicare ID - Type Unspecified
PA0007349920001Medicaid