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NPI Code Detail

MEDICARE: SAMUEL STARK

MEDICARE: SAMUEL STARK
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
1103K00000XBehavior Analyst
2106S00000XBehavior Technician

Other Identifiers

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

General Provider Information

NPI Number : 1275089104
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL STARK
Provider Business Mailing Address
First Line : 125 NE 12TH AVE
Second Line :
City : HOMESTEAD
State : FL
Zip : 33030-6215
Country : US
Telephone Number : 786-359-2406
Fax Number :
Provider Business Practice Location Address
First Line : 9260 HAMMOCKS BLVD STE 202
Second Line :
City : MIAMI
State : FL
Zip : 33196-1584
Country : US
Telephone Number : 786-353-2900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2016
Last Update Date : 09/24/2018

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Directions to “ SAMUEL STARK ” Practice Location

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