Provider Demographics
NPI:1508257734
Name:STARX ASTHMA & ALLERGY CENTER LLC
Entity Type:Organization
Organization Name:STARX ASTHMA & ALLERGY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BIELORY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-912-9817
Mailing Address - Street 1:559 LIDO LN
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1522
Mailing Address - Country:US
Mailing Address - Phone:516-721-8205
Mailing Address - Fax:
Practice Address - Street 1:400 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-2515
Practice Address - Country:US
Practice Address - Phone:973-912-9817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018274363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY018274OtherNEW YORK LICENSE