Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | OS010171-L | PA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 054671 | GA |
NPI | 1083600225 |
---|---|
Provider Name | Stefan Michael Sinco |
First Address | East Stroudsburg, PA 18301-3006 |
Second Address | East Stroudsburg, PA 18301-3006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 19/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
108490682A | (05) | GA |
I12928 | (02) | GA |