Individual
JUD STALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7030 E GENESEE ST, FAYETTEVILLE, NY 13066-1121
(315) 446-1736
Mailing address
7030 E GENESEE ST, FAYETTEVILLE, NY 13066-1121
(315) 446-1736
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
134820
NY
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
134820
NY
Other
Enumeration date
06/16/2006
Last updated
10/14/2010
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