Provider Demographics
NPI:1073331880
Name:21STARLLCC
Entity type:Organization
Organization Name:21STARLLCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:BIN
Authorized Official - Last Name:SHAUKAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-658-9178
Mailing Address - Street 1:24 HARROGATE SQ
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4051
Mailing Address - Country:US
Mailing Address - Phone:716-658-9178
Mailing Address - Fax:
Practice Address - Street 1:24 HARROGATE SQ
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-4051
Practice Address - Country:US
Practice Address - Phone:716-658-9178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:21STARLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies