Provider Demographics
NPI:1992093694
Name:STANG, JENNIFER LORRAINE (LAC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LORRAINE
Last Name:STANG
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 1:191 BELLEVUE AVE
Mailing Address - Street 2:APT B6
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1864
Mailing Address - Country:US
Mailing Address - Phone:404-512-6850
Mailing Address - Fax:
Practice Address - Street 1:191 BELLEVUE AVE
Practice Address - Street 2:APT B6
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1864
Practice Address - Country:US
Practice Address - Phone:404-512-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00082900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist