Provider Demographics
NPI:1891784567
Name:KURLANSIK, STUART L (PHD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:L
Last Name:KURLANSIK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S 17TH ST
Mailing Address - Street 2:MEDICAL TOWER - SUITE 2708
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6231
Mailing Address - Country:US
Mailing Address - Phone:215-735-2444
Mailing Address - Fax:215-735-2447
Practice Address - Street 1:255 S 17TH ST
Practice Address - Street 2:MEDICAL TOWER - SUITE 2708
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6231
Practice Address - Country:US
Practice Address - Phone:215-735-2444
Practice Address - Fax:215-735-2447
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-002988-L103TB0200X
NJ35SI00401800103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7893400Medicaid
NJR49094Medicare UPIN
NJ072819R63Medicare ID - Type Unspecified