Jud Staller, M.D.
Psychiatry & Neurology, Child & Adolescent Psychiatry in Fayetteville, NY. Individual provider (NPI-1).
NPI number1245274398
StatusActive
Last updated in NPPESOct 14, 2010
Details
- NPI
- 1245274398
- Entity type
- Individual (NPI-1)
- Name
- Jud Staller
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 16, 2006
- Last updated
- Oct 14, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology, Child & Adolescent Psychiatry | 134820 | NY | Yes |
| 2084P0800X | Psychiatry & Neurology, Psychiatry | 134820 | NY |
Practice location
7030 E Genesee StFayetteville, NY 13066-1121
Phone 315-446-1736
Mailing address
7030 E Genesee StFayetteville, NY 13066-1121
Phone 315-446-1736
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