Provider Demographics
NPI:1265623219
Name:GERALD T STASHAK MD PA
Entity type:Organization
Organization Name:GERALD T STASHAK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:STASHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-832-8886
Mailing Address - Street 1:5305 GREENWOOD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2451
Mailing Address - Country:US
Mailing Address - Phone:561-832-8886
Mailing Address - Fax:561-832-8802
Practice Address - Street 1:5305 GREENWOOD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2451
Practice Address - Country:US
Practice Address - Phone:561-832-8886
Practice Address - Fax:561-832-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057975174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty