Provider Demographics
NPI:1548236094
Name:HEALTHSTAR MEDICAL PC
Entity Type:Organization
Organization Name:HEALTHSTAR MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LADA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSIPOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-321-1286
Mailing Address - Street 1:747 MONTAUK HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795
Mailing Address - Country:US
Mailing Address - Phone:631-321-1286
Mailing Address - Fax:631-321-1379
Practice Address - Street 1:747 MONTAUK HIGHWAY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795
Practice Address - Country:US
Practice Address - Phone:631-321-1286
Practice Address - Fax:631-321-1379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEG271Medicare PIN