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General NPI Number Information
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NPI Number | 1063239432
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Entity Type | Organization
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Legal Business Name | ROCK STAR MUSIC LLC
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Dates
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Enumeration Date | 09/25/2024
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 915 KINDERKAMACK RD
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City | RIVER EDGE
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State | NJ
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Zip | 07661-2309
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Country | US
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Telephone | 201-778-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 4304 OVERLOOK CIR
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City | PIERMONT
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State | NY
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Zip | 10968-1292
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Country | US
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Telephone | 201-290-3757
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GREGG EVANS
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Credential |
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Telephone | 201-290-3757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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