Healthcare Provider Details

I. General information

NPI: 1992763387
Provider Name (Legal Business Name): JAMES M STANKIEWICZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKLINE PL SUITE 225
BROOKLINE MA
02445-7224
US

IV. Provider business mailing address

1 BROOKLINE PL SUITE 225
BROOKLINE MA
02445-7224
US

V. Phone/Fax

Practice location:
  • Phone: 617-525-6550
  • Fax: 617-525-6554
Mailing address:
  • Phone: 617-525-6550
  • Fax: 617-525-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number227028
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: