MEDICARE: MS. MAUREEN ANNE STARK MSED.

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	174400000X	Specialist		NY

General Provider Information

NPI Number	:	1104188804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAUREEN ANNE STARK MSED.

Provider Business Mailing Address
First Line	:	3207 RONIT CT
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-1933
Country	:	US
Telephone Number	:	914-438-3133
Fax Number	:

Provider Business Practice Location Address
First Line	:	3207 RONIT CT
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-1933
Country	:	US
Telephone Number	:	914-438-3133
Fax Number	:

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

Provider Enumeration Date	:	06/09/2012
Last Update Date	:	06/09/2012

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