Healthcare Provider Details

I. General information

NPI: 1154308708
Provider Name (Legal Business Name): RICHARD J SCHALLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2005
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 HWY 516
OLD BRIDGE NJ
08857-2306
US

IV. Provider business mailing address

31 WARD DR
BRICK NJ
08723-7533
US

V. Phone/Fax

Practice location:
  • Phone: 732-952-5000
  • Fax: 329-525-0057
Mailing address:
  • Phone: 908-472-3536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA06065000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA60650
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMA60650
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD448923
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMA60650
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: