Basic Information
| Provider Information | |||||||||
| NPI: | 1447213939 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENDZEJEC | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 LONG SANDS RD | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | YORK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039091158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073638430 | ||||||||
| FaxNumber: | 2073513006 | ||||||||
| Practice Location | |||||||||
| Address1: | 127 LONG SANDS RD | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | YORK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039091158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073638430 | ||||||||
| FaxNumber: | 2073513006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1287 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010467585 | 01 | AETNA HMO | OTHER | 596163 | 01 | AETNA NONHMO GROUP | OTHER | 080140515 | 01 | RAILROAD MEDICARE | OTHER | 3646359 | 01 | CIGNA HEALTHCARE | OTHER | MM2427 | 01 | MEDICARE B | OTHER | 010467585 | 01 | CHAMPUS | OTHER | 0405236YPME01 | 01 | ANTHEM BCBS NEW HAMPSHIRE | OTHER | 283840099 | 01 | PRIMECARE MEDICAID | OTHER | 596163 | 01 | AETNA HMO GROUP | OTHER | E10019 | 01 | HARVARD PILGRIM | OTHER | 010467585 | 01 | AETNA NONHMO | OTHER | YORK083565 | 01 | ANTHEM BCBS NEW HAMPSHIRE | OTHER | 010467585 | 01 | STANDARD TAX ID | OTHER | 283840099 | 05 | ME | MEDICAID | 003689 | 01 | ANTHEM BLUE CROSS BLUE SH | OTHER | 010467585 | 01 | MACHIGONNE | OTHER | 010467585001 | 01 | ANTHEM BLUE CROSS BLUE SH | OTHER |