Individual
JILL STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
104 PENSION RIDGE RD, BOOTHBAY, ME 04537-4810
(201) 294-5672
Mailing address
104 PENSION RIDGE RD, BOOTHBAY, ME 04537-4810
(201) 294-5672
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
006857
NY
Other
Enumeration date
08/23/2021
Last updated
08/23/2021
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