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Organization
FIVE STAR MEDICAL CARE PLLC
Active
Organization
FIVE STAR MEDICAL CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRYAM D REVOREDO (MANAGER)
(973) 595-7400
Entity
Organization
Contact information
Practice address
5 CARTER LN, UNIT#111, MONROE, NY 10950-6230
(973) 595-7400
(973) 345-4156
Mailing address
PO BOX 3247, WAYNE, NJ 07474-3247
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
217042-1
NY
207Q00000X
Family Medicine Physician
Primary
217042-1
NY
Other
Enumeration date
08/30/2011
Last updated
08/30/2011
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