Provider Demographics
NPI:1013320530
Name:HEALTH STAR PEDIATRICS LLC
Entity Type:Organization
Organization Name:HEALTH STAR PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-726-2375
Mailing Address - Street 1:33 E MIDLAND AVE UNIT 1822
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07653-7075
Mailing Address - Country:US
Mailing Address - Phone:201-825-3073
Mailing Address - Fax:201-825-2908
Practice Address - Street 1:685 MOUNT PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3151
Practice Address - Country:US
Practice Address - Phone:973-747-6579
Practice Address - Fax:201-825-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care