Individual
JUSTIN ZACHARY STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
225 BROADHOLLOW RD STE 402, MELVILLE, NY 11747-4899
(631) 385-7780
(631) 385-7795
Mailing address
7 WOOD LN, PLAINVIEW, NY 11803-1909
(516) 673-8207
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/08/2019
Last updated
05/08/2019
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