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General NPI Number Information
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NPI Number | 1114556602
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Entity Type | Individual
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Provider Name | JONATHAN PAUL STARK PT DPT
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Gender | Male
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 04/06/2020
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Provider Practice Location Address
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Address Line | 580 STATE ROUTE 15
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City | SPARTA
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State | NJ
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Zip | 07871-3483
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Country | US
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Telephone | 973-862-4177
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Fax |
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Provider Business Mailing Address
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Address Line | 38 PARK ST APT 11D
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-1736
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01802200
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License Number State | NJ
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