Provider Demographics
NPI:1710075130
Name:STONE, JEFFREY M (PHD BCDA)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:STONE
Suffix:
Gender:M
Credentials:PHD BCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3647
Mailing Address - Country:US
Mailing Address - Phone:908-273-5558
Mailing Address - Fax:908-273-3355
Practice Address - Street 1:86 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3647
Practice Address - Country:US
Practice Address - Phone:908-273-5558
Practice Address - Fax:908-273-3355
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2008103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ158668V6ZOtherMEDICARE GROUP MEMEBER PTAN