Provider Demographics
NPI:1245207901
Name:STONE, JENNY A (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:A
Last Name:STONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 WOODPORT RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2331
Mailing Address - Country:US
Mailing Address - Phone:973-726-3001
Mailing Address - Fax:973-726-3002
Practice Address - Street 1:156 WOODPORT RD STE 1B
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2331
Practice Address - Country:US
Practice Address - Phone:973-726-3001
Practice Address - Fax:973-726-3002
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB073888002084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8804605Medicaid
NJH18390Medicare UPIN
NJ8804605Medicaid