Healthcare Provider Details

I. General information

NPI: 1891784567
Provider Name (Legal Business Name): STUART L. KURLANSIK PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S 17TH ST MEDICAL TOWER - SUITE 2708
PHILADELPHIA PA
19103-6231
US

IV. Provider business mailing address

255 S 17TH ST MEDICAL TOWER - SUITE 2708
PHILADELPHIA PA
19103-6231
US

V. Phone/Fax

Practice location:
  • Phone: 215-735-2444
  • Fax: 215-735-2447
Mailing address:
  • Phone: 215-735-2444
  • Fax: 215-735-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS-002988-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number35SI00401800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: