Individual
DR. RAYMOND STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3959 BROADWAY, COLUMBIA UNIVERSITY DEPARTMENT PEDIATRICS, NEW YORK, NY 10032
(212) 927-3214
(212) 544-1974
Mailing address
395 RIVERSIDE DR, #14B, NEW YORK, NY 10025-1859
(212) 864-4428
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
116955
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00708452
—
NY
01
—
5998301
NEW JERSEY MEDICAID
NJ
Enumeration date
02/09/2006
Last updated
07/08/2007
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