Individual
MARY STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
67 HERITAGE LN, RIVERHEAD, NY 11901-5702
(631) 722-4636
Mailing address
67 HERITAGE LN, RIVERHEAD, NY 11901-5702
(631) 722-4636
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
345991-1
NY
Other
Enumeration date
06/20/2009
Last updated
06/20/2009
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