Healthcare Provider Details

I. General information

NPI: 1508257734
Provider Name (Legal Business Name): STARX ASTHMA & ALLERGY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MOUNTAIN AVE
SPRINGFIELD NJ
07081-2515
US

IV. Provider business mailing address

559 LIDO LN
WOODMERE NY
11598-1522
US

V. Phone/Fax

Practice location:
  • Phone: 973-912-9817
  • Fax:
Mailing address:
  • Phone: 516-721-8205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number018274
License Number StateNY

VIII. Authorized Official

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