NPIMap

Organization Active NPI

Five Star Medical Care PLLC

  • Family Medicine Physician
  • Monroe, NY
National Provider Identifier
1083995468
Registry record updated Aug 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
217042-1 Issued in NY
Legal business name
FIVE STAR MEDICAL CARE PLLC
Practice address
5 Carter LN
Unit#111
Monroe, NY 10950-6230
Phone
(973) 595-7400
Fax
(973) 345-4156
NPI assigned
Aug 30, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miryam D Revoredo
Title
Manager
Phone
(973) 595-7400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X 217042-1 NY
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 217042-1 NY Primary

Addresses

Primary practice location

5 Carter LN
Unit#111
Monroe, NY 10950-6230

Mailing address

PO Box 3247
Wayne, NJ 07474-3247

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314662400000",
    "number": "1083995468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3247",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074743247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 CARTER LN",
            "address_2": "UNIT#111",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109506230",
            "telephone_number": "973-595-7400",
            "fax_number": "973-345-4156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR MEDICAL CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-30",
        "last_updated": "2011-08-30",
        "status": "A",
        "authorized_official_last_name": "REVOREDO",
        "authorized_official_first_name": "MIRYAM",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "973-595-7400"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "217042-1",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "217042-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.