Provider Demographics
NPI:1063605673
Name:JOHN J STARKE M D P A
Entity type:Organization
Organization Name:JOHN J STARKE M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:STARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-888-0800
Mailing Address - Street 1:80 HAZLET AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1623
Mailing Address - Country:US
Mailing Address - Phone:732-888-0800
Mailing Address - Fax:732-888-4643
Practice Address - Street 1:80 HAZLET AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1623
Practice Address - Country:US
Practice Address - Phone:732-888-0800
Practice Address - Fax:732-888-4643
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNJSTARKE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-27
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2750601Medicaid
NJD96912Medicare PIN