Provider Demographics
NPI:1992797369
Name:STONE, CHESTER IRWIN (MD)
Entity type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:IRWIN
Last Name:STONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:66 SUNSET STRIP #300
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1362
Mailing Address - Country:US
Mailing Address - Phone:973-927-3388
Mailing Address - Fax:973-927-2590
Practice Address - Street 1:66 SUNSET STRIP #300
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876
Practice Address - Country:US
Practice Address - Phone:973-927-3388
Practice Address - Fax:973-927-2590
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03163500208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C56889Medicare UPIN
NJ520404Medicare ID - Type Unspecified