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General NPI Number Information
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NPI Number | 1699022756
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Entity Type | Organization
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Legal Business Name | STAR MEDICAL CARE PC
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 14040 QUEENS BLVD 2ND FLOOR
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City | JAMAICA
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State | NY
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Zip | 11435-3220
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Country | US
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Telephone | 718-480-6794
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Fax | 718-480-6985
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Provider Business Mailing Address
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Address Line | 14040 QUEENS BLVD 2ND FLOOR
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City | JAMAICA
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State | NY
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Zip | 11435-3220
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Country | US
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Telephone | 718-480-6794
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Fax | 718-480-6985
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN D ROBERTS
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Credential | MD
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Telephone | 718-480-6794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 209800000X
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Taxonomy Name | Legal Medicine (M.D./D.O.) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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