Active NPI
Eileen M. Stark, PNP
- Pediatric Nurse Practitioner
- New York, NY
National Provider Identifier
1811014376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 381742
- Practice address
- 161 Fort Washington Ave FL 7
New York, NY 10032-3729 - Phone
- (212) 305-9246
- Fax
- (212) 030-5584
- NPI assigned
- Mar 22, 2007
- 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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 381742 | NY | Primary |
Addresses
Primary practice location
161 Fort Washington Ave FL 7
New York, NY 10032-3729
Mailing address
25 Hoffman St
Maplewood, NJ 07040-1138
Phone (973) 378-8244
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 381742 | NY | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1811014376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 HOFFMAN ST",
"city": "MAPLEWOOD",
"state": "NJ",
"postal_code": "070401138",
"telephone_number": "973-378-8244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "161 FORT WASHINGTON AVE FL 7",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323729",
"telephone_number": "212-305-9246",
"fax_number": "212-030-5584"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "EILEEN",
"middle_name": "M.",
"name_prefix": "Ms.",
"credential": "PNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "NY",
"license": "381742",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, 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.