Healthcare Provider Details

I. General information

NPI: 1013095488
Provider Name (Legal Business Name): STANLEY J SKOCZYLAS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date: 02/02/2015
Reactivation Date: 06/09/2015

III. Provider practice location address

32 NANCY TERRACE WASHINGTON TOWNSHIP
HACKETTSTOWN NJ
07840
US

IV. Provider business mailing address

32 NANCY TERRACE WASHINGTON TOWNSHIP
HACKETTSTOWN NJ
07840
US

V. Phone/Fax

Practice location:
  • Phone: 908-852-7100
  • Fax: 908-813-1067
Mailing address:
  • Phone: 908-852-7100
  • Fax: 908-813-1067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMA031530
License Number StateNJ

VIII. Authorized Official

Name: STANLEY JOSEPH SKOCZYLAS
Title or Position: PHYSICIAN
Credential: MD LLC
Phone: 908-852-7100