MEDICARE: STARX ASTHMA & ALLERGY CENTER LLC

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	363AM0700X	Medical Physician Assistant	018274	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	018274	OTHER	NY	NEW YORK LICENSE

General Provider Information

NPI Number	:	1508257734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARX ASTHMA & ALLERGY CENTER LLC

Provider Business Mailing Address
First Line	:	559 LIDO LN
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1522
Country	:	US
Telephone Number	:	516-721-8205
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 MOUNTAIN AVE
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-2515
Country	:	US
Telephone Number	:	973-912-9817
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	LEONARD BIELORY
Credential	:	M.D.
Telephone Number	:	973-912-9817

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	02/10/2015

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