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Individual

EILEEN STARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA/OTR

Contact information

Practice address
85 TROLLEY RD, MONTROSE, NY 10548-1129
(914) 737-5854
(914) 737-5191
Mailing address
85 TROLLEY RD, MONTROSE, NY 10548-1129
(914) 737-5854
(914) 737-5191

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
NYSOT 005893
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
005893
NYSOT
NY
Enumeration date
12/01/2008
Last updated
12/01/2008
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