Provider Demographics
NPI:1336183920
Name:STONE, FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:STONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MCLAREN ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2408
Mailing Address - Country:US
Mailing Address - Phone:732-221-9860
Mailing Address - Fax:
Practice Address - Street 1:16 MCLAREN ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2408
Practice Address - Country:US
Practice Address - Phone:732-221-9860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03479600174400000X
PAMD441708207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ221494442OtherTAX ID#
NJ0152854Medicaid
NJ2406188000OtherAMERIHEALTH #
NJ221494442OtherTAX ID#
NJ556285Medicare ID - Type UnspecifiedMEDICARE #
NJ0152854Medicaid