Provider Demographics
NPI:1255979472
Name:STONE, CORIE (LAC)
Entity type:Individual
Prefix:
First Name:CORIE
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NORTHWEST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1616
Mailing Address - Country:US
Mailing Address - Phone:201-759-8698
Mailing Address - Fax:
Practice Address - Street 1:936 FRANKLIN LAKE RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-2153
Practice Address - Country:US
Practice Address - Phone:201-847-2341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11542651-1201171100000X
NJ25MZ00144200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist