Provider Demographics
NPI:1194847665
Name:STARK, DAVID DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DANIEL
Last Name:STARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E DILIDO DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1229
Mailing Address - Country:US
Mailing Address - Phone:212-969-9096
Mailing Address - Fax:
Practice Address - Street 1:19 HOMEWARD LN
Practice Address - Street 2:
Practice Address - City:MONTAUK
Practice Address - State:NY
Practice Address - Zip Code:11954-5295
Practice Address - Country:US
Practice Address - Phone:212-969-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA522242085R0202X
NY219922207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAS8782991OtherBNDD DEA
MAMS0583256AOtherPUBLIC HEALTH FOOD & DRUG
NY482S91Medicare UPIN
NYB74364Medicare UPIN