Healthcare Provider Details

I. General information

NPI: 1407939028
Provider Name (Legal Business Name): BRIARLY ANN STOCK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 E 29TH ST
BAYONNE NJ
07002-4654
US

IV. Provider business mailing address

308 WILLOW AVE
HOBOKEN NJ
07030-3808
US

V. Phone/Fax

Practice location:
  • Phone: 201-858-5000
  • Fax:
Mailing address:
  • Phone: 201-418-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00146400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: