Provider Demographics
NPI:1730144338
Name:ZOHAR STARK MD PC
Entity Type:Organization
Organization Name:ZOHAR STARK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZOHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-346-8686
Mailing Address - Street 1:703 WHITE HORSE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2495
Mailing Address - Country:US
Mailing Address - Phone:856-346-8686
Mailing Address - Fax:856-435-4363
Practice Address - Street 1:261 OLD YORK RD
Practice Address - Street 2:THE PAVILIONS, SUITE 304
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3706
Practice Address - Country:US
Practice Address - Phone:215-884-0313
Practice Address - Fax:856-435-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033566E207X00000X
NJ46258207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA052826Medicare PIN