MEDICARE: JEFFREY M STARK, DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	N003165-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194891424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY M STARK, DPM

Provider Business Mailing Address
First Line	:	1 DUNCAN PL
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-1306
Country	:	US
Telephone Number	:	516-765-3500
Fax Number	:	516-536-4236

Provider Business Practice Location Address
First Line	:	1 DUNCAN PL
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-1306
Country	:	US
Telephone Number	:	516-765-3500
Fax Number	:	516-536-4236

Authorized Official
Title or Position	:	PODIATRIST
Name	:	JEFFREY M STARK
Credential	:	DPM
Telephone Number	:	516-764-3500

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	05/08/2008

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