Individual
EDWARD STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
355 W 52ND ST, NEW YORK, NY 10019-6239
(646) 754-2100
(646) 754-2148
Mailing address
355 W 52ND ST, NEW YORK, NY 10019-6239
(646) 754-2100
(646) 754-2148
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
041680
GA
208800000X
Urology Physician
Primary
179696
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000707891G
—
GA
01
—
340015407
RAILROAD MEDICARE
GA
Enumeration date
08/13/2006
Last updated
10/15/2024
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