Individual
LARISSA STATHAKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
750 BRUNSWICK AVE, HELENE FULD MEDICAL CENTER, TRENTON, NJ 08638-4143
(800) 345-0064
(973) 251-1109
Mailing address
PO BOX 747, LIVINGSTON, NJ 07039-0747
(800) 345-0064
(973) 251-1109
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00221400
NJ
363A00000X
Physician Assistant
—
—
Other
Enumeration date
07/22/2009
Last updated
06/20/2022
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