Healthcare Provider Details

I. General information

NPI: 1487154597
Provider Name (Legal Business Name): FIVE STAR ASSESSMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 47 STREET SUITE 2
ASTORIA NY
11105
US

IV. Provider business mailing address

2135 47TH STREET SUITE 2
ASTORIA NY
11105
US

V. Phone/Fax

Practice location:
  • Phone: 347-867-2143
  • Fax:
Mailing address:
  • Phone: 347-867-2143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1201X
TaxonomyOptometric Assistant Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN VILLA
Title or Position: PRESIDENT
Credential:
Phone: 347-867-2143