Provider Demographics
NPI:1962550103
Name:ANTHONY, STAR (DC)
Entity type:Individual
Prefix:DR
First Name:STAR
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BEACON HILL RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3034
Mailing Address - Country:US
Mailing Address - Phone:516-944-8559
Mailing Address - Fax:
Practice Address - Street 1:64 BEACON HILL RD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3034
Practice Address - Country:US
Practice Address - Phone:516-944-8559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC06041-0OtherWORKERS' COMPENSATION
NYX3765Medicare ID - Type Unspecified
NYC06041-0OtherWORKERS' COMPENSATION