Healthcare Provider Details

I. General information

NPI: 1043541451
Provider Name (Legal Business Name): STARX ALLERGY & ASTHMA CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MOUNTAIN AVE
SPRINGFIELD NJ
07081-2515
US

IV. Provider business mailing address

400 MOUNTAIN AVE
SPRINGFIELD NJ
07081-2515
US

V. Phone/Fax

Practice location:
  • Phone: 973-912-9817
  • Fax: 206-333-1884
Mailing address:
  • Phone: 973-912-9817
  • Fax: 206-333-1884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25MA04594700
License Number StateNJ

VIII. Authorized Official

Name: DR. LEONARD BIELORY
Title or Position: MEMBER
Credential: M.D.
Phone: 973-912-9817