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General NPI Number Information
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NPI Number | 1134858418
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Entity Type | Individual
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Provider Name | JASON ROBERT STEPHANSKY PA
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Gender | Male
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 335 BRIGHTON AVE STE 200
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City | PORTLAND
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State | ME
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Zip | 04102-2362
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Country | US
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Telephone | 207-662-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 1130 WASHINGTON ST
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City | WHITMAN
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State | MA
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Zip | 02382-1236
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Country | US
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Telephone | 781-710-0072
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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