# FIVE STAR MEDICAL CARE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083995468
- **Authorized official:** MIRYAM D REVOREDO (MANAGER)
- **Authorized official phone:** (973) 595-7400

## Contact information

- **Practice address:** 5 CARTER LN, UNIT\#111, MONROE, NY 10950-6230
- **Practice address phone:** (973) 595-7400
- **Practice address fax:** (973) 345-4156
- **Mailing address:** PO BOX 3247, WAYNE, NJ 07474-3247

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | 217042-1 | NY | — |
| 207Q00000X | Family Medicine Physician | 217042-1 | NY | Yes |

## Other

- **Enumeration date:** 08/30/2011
- **Last updated:** 08/30/2011