Provider Demographics
NPI:1376235366
Name:STONE, MYRNISSA A
Entity Type:Individual
Prefix:
First Name:MYRNISSA
Middle Name:A
Last Name:STONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MYRNISSA
Other - Middle Name:A
Other - Last Name:STONE-SUMAIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:518 MARTINELLI AVE
Mailing Address - Street 2:
Mailing Address - City:MINOTOLA
Mailing Address - State:NJ
Mailing Address - Zip Code:08341-1210
Mailing Address - Country:US
Mailing Address - Phone:516-410-8892
Mailing Address - Fax:908-325-0359
Practice Address - Street 1:518 MARTINELLI AVE
Practice Address - Street 2:
Practice Address - City:MINOTOLA
Practice Address - State:NJ
Practice Address - Zip Code:08341-1210
Practice Address - Country:US
Practice Address - Phone:516-410-8892
Practice Address - Fax:908-325-0359
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No372500000XNursing Service Related ProvidersChore Provider
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel