MEDICARE: SPECIAL STARS CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1043033079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIAL STARS CORPORATION

Provider Business Mailing Address
First Line	:	2032 E 63RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5910
Country	:	US
Telephone Number	:	929-405-7639
Fax Number	:

Provider Business Practice Location Address
First Line	:	2032 E 63RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5910
Country	:	US
Telephone Number	:	929-405-7639
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GULISTAN IMAMOVA
Credential	:	MSED
Telephone Number	:	929-405-7639

Provider Enumeration Date	:	11/07/2024
Last Update Date	:	11/07/2024

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Directions to “SPECIAL STARS CORPORATION ” Practice Location

Language	Start Address	Practice Location

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