Provider Demographics
NPI:1013095488
Name:STANLEY J SKOCZYLAS MD LLC
Entity Type:Organization
Organization Name:STANLEY J SKOCZYLAS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SKOCZYLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD LLC
Authorized Official - Phone:908-852-7100
Mailing Address - Street 1:32 NANCY TERRACE
Mailing Address - Street 2:WASHINGTON TOWNSHIP
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840
Mailing Address - Country:US
Mailing Address - Phone:908-852-7100
Mailing Address - Fax:908-813-1067
Practice Address - Street 1:32 NANCY TERRACE
Practice Address - Street 2:WASHINGTON TOWNSHIP
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-852-7100
Practice Address - Fax:908-813-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:2015-02-02
Deactivation Code:
Reactivation Date:2015-06-09
Provider Licenses
StateLicense IDTaxonomies
NJMA031530207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA031530OtherLICENSURE
NJ1685503Medicaid
NJ1685503Medicaid
NJ152441VW5Medicare ID - Type Unspecified
NJSK152441Medicare ID - Type Unspecified