Provider Demographics
NPI:1558988444
Name:THIRD STONE INTEGRATIVE HEALTH CENTER
Entity Type:Organization
Organization Name:THIRD STONE INTEGRATIVE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCYK
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:860-572-9566
Mailing Address - Street 1:3 WILDWOOD MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1155
Mailing Address - Country:US
Mailing Address - Phone:860-661-4662
Mailing Address - Fax:860-661-4654
Practice Address - Street 1:3 WILDWOOD MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1155
Practice Address - Country:US
Practice Address - Phone:860-661-4662
Practice Address - Fax:860-661-4654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447616941OtherNPPES