Active NPI
Mary E Stark, RN
- Registered Nurse
- Goshen, NY
National Provider Identifier
1255413944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 325079
- Practice address
- 30 Harriman Drive
Goshen, NY 10924 - Phone
- (845) 858-2600
- Fax
- (845) 858-2628
- NPI assigned
- Oct 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 325079 | NY | Primary |
Addresses
Primary practice location
30 Harriman Drive
Goshen, NY 10924
Mailing address
146 Pike Street
Port Jervis, NY 12771
Phone (845) 858-1456
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 325079 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255413944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "146 PIKE STREET",
"city": "PORT JERVIS",
"state": "NY",
"postal_code": "12771",
"telephone_number": "845-858-1456",
"fax_number": "845-858-1459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 HARRIMAN DRIVE",
"city": "GOSHEN",
"state": "NY",
"postal_code": "10924",
"telephone_number": "845-858-2600",
"fax_number": "845-858-2628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "MARY",
"middle_name": "E",
"name_prefix": "Ms.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "325079",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goshen, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.