Basic Information
| Provider Information | |||||||||
| NPI: | 1295777613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NERENSTONE | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 RETREAT AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061062527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602496291 | ||||||||
| FaxNumber: | 8607280151 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 RETREAT AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061062527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602496291 | ||||||||
| FaxNumber: | 8607280151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 12/11/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 029763 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 001297630 | 05 | CT | MEDICAID |