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General NPI Number Information
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NPI Number | 1700031812
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Entity Type | Organization
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Legal Business Name | STEFAN L. STANESCU, MD, PA
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 105 SOUTHPARK BLVD STE C300
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4162
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Country | US
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Telephone | 904-797-2663
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Fax | 904-819-0997
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Provider Business Mailing Address
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Address Line | PO BOX 9018
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City | ST AUGUSTINE
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State | FL
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Zip | 32085-9018
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Country | US
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Telephone | 904-797-2663
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Fax | 904-819-0997
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Authorized Official
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Title or Position | OWNER
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Name | STEFAN LUCIAN STANESCU
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Credential | MD
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Telephone | 904-797-2663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | ME0076144
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME0076144
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License Number State | FL
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