MEDICARE: CORIE STONE L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	11542651-1201	UT
2	171100000X	Acupuncturist	25MZ00144200	NJ

General Provider Information

NPI Number	:	1255979472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORIE STONE L.AC.

Provider Business Mailing Address
First Line	:	10 NORTHWEST ST
Second Line	:
City	:	LINCOLN PARK
State	:	NJ
Zip	:	07035-1616
Country	:	US
Telephone Number	:	201-759-8698
Fax Number	:

Provider Business Practice Location Address
First Line	:	936 FRANKLIN LAKE RD
Second Line	:
City	:	FRANKLIN LAKES
State	:	NJ
Zip	:	07417-2153
Country	:	US
Telephone Number	:	201-847-2341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2019
Last Update Date	:	03/10/2020

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Directions to “ CORIE STONE L.AC.” Practice Location

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