Basic Information
| Provider Information | |||||||||
| NPI: | 1407939028 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOCK | ||||||||
| FirstName: | BRIARLY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 176 PALISADE AVE | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073061121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2017958200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 176 PALISADE AVE | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073061121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2017958200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 10/28/2012 | ||||||||
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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 | 363A00000X | 25MP00146400 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 2255A2300X | 25MT00116300 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.