Provider Demographics
NPI:1932359973
Name:STANEK, JERZY WACLAW (MD)
Entity Type:Individual
Prefix:
First Name:JERZY
Middle Name:WACLAW
Last Name:STANEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE., ML 1010
Mailing Address - Street 2:CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-4261
Mailing Address - Fax:513-636-3924
Practice Address - Street 1:3333 BURNET AVE., ML 1010
Practice Address - Street 2:CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-4261
Practice Address - Fax:513-636-3924
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.066862207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology