Provider Demographics
NPI:1053566125
Name:ASUN STAR COMMUNITY OUTREACH
Entity type:Organization
Organization Name:ASUN STAR COMMUNITY OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:NICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-681-3747
Mailing Address - Street 1:199 RAILROAD AVE STE 3A
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1915
Mailing Address - Country:US
Mailing Address - Phone:973-771-3300
Mailing Address - Fax:973-679-2784
Practice Address - Street 1:199 RAILROAD AVE STE 3A
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1915
Practice Address - Country:US
Practice Address - Phone:973-771-3300
Practice Address - Fax:973-679-2784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0161497Medicaid