Provider Demographics
NPI:1043670961
Name:STANLEY LOBITZ MD LLC
Entity type:Organization
Organization Name:STANLEY LOBITZ MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-283-5611
Mailing Address - Street 1:155 E BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4940
Mailing Address - Country:US
Mailing Address - Phone:570-283-5611
Mailing Address - Fax:570-283-5613
Practice Address - Street 1:155 E BENNETT ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-4940
Practice Address - Country:US
Practice Address - Phone:570-283-5611
Practice Address - Fax:570-283-5613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760457121Medicare PIN