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General NPI Number Information
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NPI Number | 1619299559
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Entity Type | Organization
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Legal Business Name | STARK PEDIATRICS INC
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Dates
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Enumeration Date | 02/19/2010
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Last Update Date | 02/19/2010
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Provider Practice Location Address
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Address Line | 3030 TUSCARAWAS ST W SUITE 300
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City | CANTON
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State | OH
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Zip | 44708-4197
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Country | US
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Telephone | 330-452-6109
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Fax | 330-452-5060
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Provider Business Mailing Address
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Address Line | 3030 TUSCARAWAS ST W SUITE 300
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City | CANTON
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State | OH
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Zip | 44708-4197
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Country | US
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Telephone | 330-452-6109
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Fax | 330-452-5060
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ASIF YOUNUS
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Credential | MD
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Telephone | 330-452-6109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35076415Y
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License Number State | OH
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