Provider Demographics
NPI:1306082599
Name:STAR DIAGNOSTIC SERVICES, INC
Entity type:Organization
Organization Name:STAR DIAGNOSTIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETLYARSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-673-7427
Mailing Address - Street 1:1959 82ND ST
Mailing Address - Street 2:#3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2305
Mailing Address - Country:US
Mailing Address - Phone:718-909-0967
Mailing Address - Fax:
Practice Address - Street 1:1959 82ND ST
Practice Address - Street 2:#3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2305
Practice Address - Country:US
Practice Address - Phone:718-909-0967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory