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NPI Code Detail

MEDICARE: PAUL STACK

MEDICARE: PAUL STACK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041S0200XSchool Social Worker122088NY

General Provider Information

NPI Number : 1295561918
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL STACK
Provider Business Mailing Address
First Line : 1951 SENECA AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14617-4802
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 950 NORTON ST
Second Line :
City : ROCHESTER
State : NY
Zip : 14621-3732
Country : US
Telephone Number : 585-467-3131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2024
Last Update Date : 09/10/2024

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Directions to “ PAUL STACK ” Practice Location

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