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General NPI Number Information
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NPI Number | 1588943047
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Entity Type | Organization
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Legal Business Name | J&J STAR MEDICAL PLLC
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Dates
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Enumeration Date | 08/15/2011
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Last Update Date | 08/15/2011
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Provider Practice Location Address
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Address Line | 9320 70TH AVE
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City | FOREST HILLS
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State | NY
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Zip | 11375-5828
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Country | US
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Telephone | 917-292-2292
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Fax |
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Provider Business Mailing Address
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Address Line | 7204 JUNO ST
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City | FOREST HILLS
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State | NY
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Zip | 11375-5930
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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 | MANAGER
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Name | JIM LI
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Credential |
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Telephone | 917-292-2292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 224860
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License Number State | NY
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