Active NPI
Justin Zachary Stark
- Behavior Technician
- Melville, NY
National Provider Identifier
1568027142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 225 Broadhollow Rd Ste 402
Melville, NY 11747-4899 - Phone
- (631) 385-7780
- Fax
- (631) 385-7795
- NPI assigned
- May 8, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
225 Broadhollow Rd Ste 402
Melville, NY 11747-4899
Mailing address
7 Wood LN
Plainview, NY 11803-1909
Phone (516) 673-8207
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557273600000",
"number": "1568027142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 WOOD LN",
"city": "PLAINVIEW",
"state": "NY",
"postal_code": "118031909",
"telephone_number": "516-673-8207"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 BROADHOLLOW RD STE 402",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117474899",
"telephone_number": "631-385-7780",
"fax_number": "631-385-7795"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "JUSTIN",
"middle_name": "ZACHARY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-08",
"last_updated": "2019-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.