Provider Demographics
NPI:1891395463
Name:MK STAR INC
Entity Type:Organization
Organization Name:MK STAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION TEACHER
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURAVINA
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:917-365-9833
Mailing Address - Street 1:104 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4400
Mailing Address - Country:US
Mailing Address - Phone:917-365-9833
Mailing Address - Fax:718-979-0407
Practice Address - Street 1:104 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4400
Practice Address - Country:US
Practice Address - Phone:917-365-9833
Practice Address - Fax:718-979-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1922360338OtherSPECIAL EDUCATION TEACHER