MEDICARE: FIVE STAR MEDICAL OFFICE PC

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	207R00000X	Internal Medicine Physician	265676	NY
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1760731459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE STAR MEDICAL OFFICE PC

Provider Business Mailing Address
First Line	:	PO BOX 801280
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-1280
Country	:	US
Telephone Number	:	718-576-4652
Fax Number	:	516-710-7846

Provider Business Practice Location Address
First Line	:	10407 METROPOLITAN AVE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6735
Country	:	US
Telephone Number	:	718-576-4652
Fax Number	:	516-710-7846

Authorized Official
Title or Position	:	VP REVENUE MANAGEMENT
Name	:	DR. CELESTE DAYE
Credential	:
Telephone Number	:	470-553-3591

Provider Enumeration Date	:	09/10/2012
Last Update Date	:	03/15/2023

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Directions to “FIVE STAR MEDICAL OFFICE PC ” Practice Location

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