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General NPI Number Information
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NPI Number | 1366415358
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Entity Type | Individual
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Provider Name | DR. RAYMOND STARK
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Gender | Male
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3959 BROADWAY COLUMBIA UNIVERSITY DEPARTMENT PEDIATRICS
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City | NEW YORK
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State | NY
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Zip | 10032
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Country | US
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Telephone | 212-927-3214
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Fax | 212-544-1974
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Provider Business Mailing Address
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Address Line | 395 RIVERSIDE DR #14B
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City | NEW YORK
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State | NY
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Zip | 10025-1859
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Country | US
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Telephone | 212-864-4428
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 116955
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License Number State | NY
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