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General NPI Number Information
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NPI Number | 1437762283
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Entity Type | Organization
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Legal Business Name | STAR TRACK HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 08/30/2020
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Last Update Date | 08/30/2020
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Provider Practice Location Address
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Address Line | 236 RIDGE AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-3448
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Country | US
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Telephone | 732-370-0317
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Fax |
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Provider Business Mailing Address
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Address Line | 236 RIDGE AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-3448
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Country | US
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Telephone | 732-370-0317
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | TOVA FISHER
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Credential |
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Telephone | 732-370-0317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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