Provider Demographics
NPI:1033273594
Name:THE STONE CENTER OF NEW JERSEY, LLC
Entity Type:Organization
Organization Name:THE STONE CENTER OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-564-5642
Mailing Address - Street 1:150 BERGEN ST
Mailing Address - Street 2:PO BOX 1709
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2496
Mailing Address - Country:US
Mailing Address - Phone:862-235-1983
Mailing Address - Fax:862-235-1984
Practice Address - Street 1:830 MORRIS TPKE
Practice Address - Street 2:SUITE 303
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2625
Practice Address - Country:US
Practice Address - Phone:973-564-5642
Practice Address - Fax:973-564-5024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22255261QL0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0114391Medicaid