Provider Demographics
NPI:1508302076
Name:STARK, NOAH (DPM)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:
Last Name:STARK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 CLINTON ST
Mailing Address - Street 2:APARTMENT 410
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-3133
Mailing Address - Country:US
Mailing Address - Phone:973-699-6360
Mailing Address - Fax:
Practice Address - Street 1:318 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204
Practice Address - Country:US
Practice Address - Phone:908-687-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00340400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist