LYLE D STARK (NPI# 1306946819) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306946819 |
| Entity Type | Individual |
| Full Name | LYLE D STARK |
| Credential | P.A. |
| Practice Address |
111 Central Ave Fl 3 Newark NJ 07102-1909 |
| Mailing Address |
68 South Service Road Suite 350 Melville NY 11747 |
| Practice Telephone | 9738775300 |
| Practice Fax Number | 9738772621 |
| Mailing Telephone | 5169453357 |
| Mailing Fax Number | 5169453131 |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2015-03-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
25MP00094700 | NJ | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
111 CENTRAL AVE FL 3 |
| City | NEWARK |
| State | NJ |
| Zip Code | 07102-1909 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043310527 | Anthony H Hamded | Physician Assistant | 111 Central Ave Fl 3, Newark, NJ 07102-1909 | 2006-09-24 |
| 1215149133 | Richard M Vitali | Physician Assistant | 111 Central Ave Fl 3, Newark, NJ 07102-1909 | 2007-05-04 |
| 1376670653 | Denise Corona | Physician Assistant | 111 Central Ave Fl 3, Newark, NJ 07102-1909 | 2007-02-27 |
| 1932244910 | Roger Stein | Physician Assistant | 111 Central Ave Fl 3, Newark, NJ 07102-1909 | 2007-02-20 |
| 1881739852 | Lori A Pennell | Nurse Practitioner | 111 Central Ave Fl 3, Newark, NJ 07102-1909 | 2007-02-20 |
| 1750472346 | Natalie Klinoff | Physician Assistant | 111 Central Ave Fl 3, Newark, NJ 07102-1909 | 2006-09-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487253779 | Integrity, Inc | Clinic/Center | 1091-1093 Broad Street, Newark, NJ 07102 | 2020-10-19 |
| 1881292720 | Oluwaseun Ademulegun | Pharmacist | 1084 Broad Street, Newark, Newark, NJ 07102 | 2020-10-13 |
| 1679042295 | Henry Paul Grayner | Specialist/Technologist | 100 Lock St, Newark, NJ 07102 | 2018-11-14 |
| 1548736838 | Integrity, Inc | Substance Abuse Rehabilitation Facility | 101 Lincoln Park, 2nd Floor, Newark, NJ 07102 | 2018-10-15 |
| 1962981407 | Crystal Kay-baune Mccown | Social Worker | 130 Orange St, Newark, NJ 07102 | 2018-08-07 |
| 1053808865 | Nubi Consultants Corp. Dba Aplus Home Care | Physical Therapist | 11 Franklin Street, 11 Franklin Street, Newark, NJ 07102 | 2018-04-17 |
| 1396249264 | Integrity, Inc | Substance Abuse Rehabilitation Facility | 49 Lincoln Park, Newark, NJ 07102 | 2018-03-23 |
| 1568960896 | Saint James Health Inc | Clinic/Center | 36 Halsey Street, Newark, NJ 07102 | 2018-02-01 |
| 1992216527 | Metropolitan Center for Human Services | Psychologist | 520 Dr. Martin Luther King, Jr. Boulevard, Newark, NJ 07102 | 2017-10-23 |
| 1467974949 | Ahmad Mohammad Tawfiq Damati | Student in an Organized Health Care Education/Training Program | 123 University Ave, Newark, Nj 07102, Newark, NJ 07102 | 2017-07-17 |
| Find all providers in zip 07102 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992104962 | Jessica Nackley | Physician Assistant | 1200 Driving Park Ave Ste 4, Newark, NY 14513-1090 | 2014-08-15 |
| 1831304682 | Geraldine Redmond | Physician Assistant | 150 Bergen St., E - Level Rm# E346, Newark, NJ 07103 | 2007-05-14 |
| 1285856716 | Jill Rachel Mermagen | Physician Assistant | 4755 Stanton Ogletown Road, Newark, DE 19711 | 2007-05-03 |
| 1679794473 | North Jersey Orthopaedic Group | Physician Assistant | 90 Bergen St Ste 1200, Newark, NJ 07103-2425 | 2007-05-01 |
| 1073697330 | Krista Wark Rogaski | Physician Assistant | 90 Bergen St # 8100, Newark, NJ 07103-2425 | 2006-10-24 |
| 1043310527 | Anthony H Hamded | Physician Assistant | 111 Central Ave Fl 3, Newark, NJ 07102-1909 | 2006-09-24 |
| 1922614981 | Kalette Demarrais | Physician Assistant | 1096 Old Churchmans Rd, Newark, DE 19713-2102 | 2020-09-16 |
| 1477162725 | Aidan Sullivan | Physician Assistant | 1200 Driving Park Ave, Newark, NY 14513-1090 | 2020-07-23 |
| 1871064352 | Cassandra Barker | Physician Assistant | 150 Bergen St, Newark, NJ 07103-2496 | 2018-12-10 |
| 1881161198 | Kaitlyn A Tytka | Physician Assistant | 1200 Driving Park Ave Ste 4, Newark, NY 14513-1090 | 2018-10-25 |
| Find all providers in NEWARK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.