Healthcare Provider Details

I. General information

NPI: 1366354805
Provider Name (Legal Business Name): JOSEPH WOLF SKALLER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SAINT NICHOLAS AVE
BROOKLYN NY
11237-6566
US

IV. Provider business mailing address

276 14TH ST
BROOKLYN NY
11215-4912
US

V. Phone/Fax

Practice location:
  • Phone: 929-296-6790
  • Fax: 929-300-0280
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: