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General NPI Number Information
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NPI Number | 1962589648
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Entity Type | Individual
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Provider Name | LAURI STARK LAST D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 2857 JERUSALEM AVE
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City | WANTAGH
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State | NY
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Zip | 11793-2018
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Country | US
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Telephone | 516-785-2783
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Fax | 516-785-2584
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Provider Business Mailing Address
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Address Line | 1046 OLD BRITTON RD
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City | NORTH BELLMORE
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State | NY
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Zip | 11710-1723
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Country | US
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Telephone | 516-221-6338
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 167122
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License Number State | NY
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