| Staller Family Practice | |
|
23 S 1st Ave Highland Park NJ 08904-2113 | |
| (732) 874-6063 | |
| Not Available |
| Full Name | Staller Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 23 S 1st Ave, Highland Park, New Jersey |
| Authorized Official Name and Position | Branden Staller (DOCTOR) |
| Authorized Official Contact | 7328746063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Staller Family Practice 23 S 1st Ave Highland Park NJ 08904-2113 Ph: (732) 874-6063 | Staller Family Practice 23 S 1st Ave Highland Park NJ 08904-2113 Ph: (732) 874-6063 |
| NPI Number | 1700529815 |
|---|---|
| Provider Enumeration Date | 04/16/2022 |
| Last Update Date | 06/22/2023 |
| Medicare PECOS PAC ID | 6002288362 |
|---|---|
| Medicare Enrollment ID | O20230214002390 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700529815 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Branden Staller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760921043 PECOS PAC ID: 7810369170 Enrollment ID: I20230214002578 |
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