Provider Demographics
NPI:1548211915
Name:STAR MEDICAL OFFICES P.C.
Entity Type:Organization
Organization Name:STAR MEDICAL OFFICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMOCLEIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTESMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-934-4842
Mailing Address - Street 1:415 OCEAN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6828
Mailing Address - Country:US
Mailing Address - Phone:718-934-4842
Mailing Address - Fax:718-616-0165
Practice Address - Street 1:415 OCEAN VIEW AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6828
Practice Address - Country:US
Practice Address - Phone:718-934-4842
Practice Address - Fax:718-616-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211150207R00000X
NY144701207RC0000X
NY181011207RG0100X
NY203695207RH0003X
NY238025208100000X
NY236385208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW85551Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY04342Medicare PIN