Healthcare Provider Details

I. General information

NPI: 1720159643
Provider Name (Legal Business Name): AMY S. STARR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 BEACH 148TH STREET
ROCKAWAY PARK NY
11694-1016
US

IV. Provider business mailing address

171 BEACH 148TH ST
ROCKAWAY PARK NY
11694-1016
US

V. Phone/Fax

Practice location:
  • Phone: 323-574-1811
  • Fax:
Mailing address:
  • Phone: 323-574-1811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License NumberG36587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: