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General NPI Number Information
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NPI Number | 1891395463
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Entity Type | Organization
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Legal Business Name | MK STAR INC
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Dates
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Enumeration Date | 10/31/2020
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Last Update Date | 10/31/2020
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Provider Practice Location Address
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Address Line | 104 LINWOOD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-4400
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Country | US
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Telephone | 917-365-9833
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Fax | 718-979-0407
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Provider Business Mailing Address
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Address Line | 104 LINWOOD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-4400
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Country | US
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Telephone | 917-365-9833
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Fax | 718-979-0407
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Authorized Official
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Title or Position | SPECIAL EDUCATION TEACHER
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Name | YELENA MURAVINA
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Credential | M.S.ED.
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Telephone | 917-365-9833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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