JUD STALLER (NPI# 1245274398) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245274398 |
| Entity Type | Individual |
| Full Name | JUD STALLER |
| Credential | M.D. |
| Practice Address |
7030 E Genesee St Fayetteville NY 13066-1121 |
| Practice Telephone | 3154461736 |
| Mailing Telephone | 3154461736 |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2010-10-14 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
134820 | NY | Allopathic & Osteopathic Physicians |
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
134820 | NY | Allopathic & Osteopathic Physicians |
| Street Address |
7030 E GENESEE ST |
| City | FAYETTEVILLE |
| State | NY |
| Zip Code | 13066-1121 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275839821 | Niamh Doyle | Psychologist | 7030 E Genesee St, Fayetteville, NY 13066-1121 | 2011-01-31 |
| 1205089992 | Consultation Services of Central New York - Medicine Provider, Pllc | Clinic/Center | 7030 E Genesee St, Suite 109, Fayetteville, NY 13066-1121 | 2008-10-28 |
| 1568635290 | Maria Ditullio | Counselor | 7030 E Genesee St, Fayetteville, NY 13066-1121 | 2008-04-02 |
| 1780893792 | Matthew Henry Rosa | Psychiatry & Neurology | 7030 E Genesee St, Suite 109, Fayetteville, NY 13066-1121 | 2007-05-22 |
| 1386857217 | Jill Weldum | Marriage & Family Therapist | 7030 E Genesee St, Fayetteville, NY 13066-1121 | 2007-05-07 |
| 1487792438 | Lynn Carol Koss | Speech-Language Pathologist | 7030 E Genesee St, The White House Professional Offices, Fayetteville, NY 13066-1121 | 2007-02-02 |
| 1982793824 | Cornelia Maria Buur | Social Worker | 7030 E Genesee St, Fayetteville, NY 13066-1121 | 2006-10-11 |
| 1063509552 | Tracy A Lunney | Counselor | 7030 E Genesee St, Fayetteville, NY 13066-1121 | 2006-10-06 |
| 1265455620 | Mary Elizabeth Jeannotte | Psychologist | 7030 E Genesee St, Fayetteville, NY 13066 | 2006-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457819963 | Word Wellness Center, LLC | Psychologist | 6836 E Genesee Street, Suite A, Fayetteville, NY 13066 | 2019-03-05 |
| 1629529060 | Lorna Boyer Chase | Marriage & Family Therapist | 109 White Heron Circle, Fayetteville, NY 13066 | 2016-10-20 |
| 1699221432 | Roman Batyuk | Nurse Practitioner | 4100 Medical Center Drive, Fayetteville, NY 13066 | 2016-08-31 |
| 1427405133 | National Eye Care, Inc | Optometrist | 5160 Kinloch Circle, Fayetteville, NY 13066 | 2016-05-23 |
| 1013375328 | Kristin Kukenberger | Chiropractor | 7000 E Genesee St Bldg B, Fayetteville, NY 13066 | 2016-02-01 |
| 1124394671 | Susan Hartman Brenizer | Marriage & Family Therapist | 7000 E Genesee St Lyndon Office Park, Bldg. A, Second Floor (upper Level), Fayetteville, NY 13066 | 2012-03-29 |
| 1245541432 | Rene L Converse | Occupational Therapist | 7200 E. Genesee Street, Fayetteville, NY 13066 | 2010-06-23 |
| 1689815805 | Menorah Park Group Residents | Clinic/Center | 12 Jamar Drive, Dewitt, NY 13066 | 2009-03-18 |
| 1063677458 | John Marcena Glezen | Obstetrics & Gynecology | 1 The Gazebo, Fayetteville, NY 13066 | 2008-07-24 |
| 1629232418 | Tucker Martin Harris | Otolaryngology | 4000 Medical Center Dr # 117, Fayetteville, NY 13066 | 2008-07-11 |
| Find all providers in zip 13066 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366619652 | Alaris Behavioral Services, P.C. | Psychiatry & Neurology | 110 Habersham Dr, Suite 146, Fayetteville, GA 30214-1381 | 2008-05-15 |
| 1548381510 | Kathryn A Panek | Psychiatry & Neurology | 74 W Sunbridge Dr, Suite 1, Fayetteville, AR 72703-1822 | 2007-04-03 |
| 1689617417 | Norman I Snyder | Psychiatry & Neurology | 4253 N Crossover Rd, Suite 2, Fayetteville, AR 72703-4593 | 2006-06-13 |
| 1538125448 | Eric Jean Lespes | Psychiatry & Neurology | 250 Sawtooth Dr, Fayetteville, NC 28314-4536 | 2006-04-21 |
| 1316118326 | Matthew J. Crouch, Md, Pllc | Psychiatry & Neurology | 1 W Sunbridge Dr, Fayetteville, AR 72703-1825 | 2008-03-18 |
| 1659401453 | County of Cumberland | Psychiatry & Neurology | 711 Executive Pl, Fayetteville, NC 28305-5193 | 2007-03-07 |
| 1750412516 | County of Cumberland | Psychiatry & Neurology | 1724 Roxie Ave, Fayetteville, NC 28304-1623 | 2007-03-07 |
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| 1023632015 | Child and Adult Clinical Psychiatry PC | Psychiatry & Neurology | 75 Prospect St Ste 110, Huntington, NY 11743-3320 | 2020-06-04 |
| 1598306441 | Place of Mind Child, Adolescent, and Adult Psychiatry P.C. | Psychiatry & Neurology | 240 Central Park S Apt 2h, New York, NY 10019-1435 | 2019-10-02 |
| 1881102267 | Park Avenue Physicians PC | Psychiatry & Neurology | 5 W 86th St Apt 1b, New York, NY 10024-3663 | 2018-01-19 |
| 1518478080 | Diego G. Calabria Physician P.C. | Psychiatry & Neurology | 366 N Broadway Ste 304, Jericho, NY 11753-2000 | 2017-10-23 |
| 1013426865 | Bebsy Estefan Md PC | Psychiatry & Neurology | 3050 Corlear Ave # Phb, Bronx, NY 10463-5180 | 2017-09-25 |
| 1902281629 | Derek Rudge | Psychiatry & Neurology | 1051 Riverside Dr Rm 235, New York, NY 10032-1007 | 2015-07-23 |
| 1275918096 | Dr Omar Bashayan Physician Pllc | Psychiatry & Neurology | 155 W 68th St Apt 1102, New York, NY 10023-5816 | 2015-07-22 |
| 1740676766 | Maura E Tappen | Psychiatry & Neurology | 1860 South Ave, Rochester, NY 14620-4229 | 2015-04-07 |
| 1194119560 | Krishen Persaud | Psychiatry & Neurology | Stony Brook Psychiatric Associates, Ufpc, Sbumc, Hsc Level 10, Rm.020, Stony Brook, NY 11794-8101 | 2015-03-24 |
| Find all providers with the same taxonomy | ||||
| City | FAYETTEVILLE |
| Zip Code | 13066 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.