MEDICARE: STAR MEDICAL OFFICES P.C.

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	207RC0000X	Cardiovascular Disease Physician	144701	NY
2	207RG0100X	Gastroenterology Physician	181011	NY
3	207RH0003X	Hematology & Oncology Physician	203695	NY
4	208100000X	Physical Medicine & Rehabilitation Physician	238025	NY
5	208800000X	Urology Physician	236385	NY
6	207R00000X	Internal Medicine Physician	211150	NY

General Provider Information

NPI Number	:	1548211915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR MEDICAL OFFICES P.C.

Provider Business Mailing Address
First Line	:	415 OCEAN VIEW AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6828
Country	:	US
Telephone Number	:	718-934-4842
Fax Number	:	718-616-0165

Provider Business Practice Location Address
First Line	:	415 OCEAN VIEW AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6828
Country	:	US
Telephone Number	:	718-934-4842
Fax Number	:	718-616-0165

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEMOCLEIA GOTTESMAN
Credential	:	MD
Telephone Number	:	718-934-4842

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	10/04/2007

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