Healthcare Provider Details

I. General information

NPI: 1356256531
Provider Name (Legal Business Name): STEPHEN GOELLER JR FAMILY HEALTH NP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 5TH AVE SIDE DOOR
NEW YORK NY
10021
US

IV. Provider business mailing address

228 E ROUTE 59 # 144
NANUET NY
10954-2905
US

V. Phone/Fax

Practice location:
  • Phone: 929-269-3020
  • Fax: 929-333-7998
Mailing address:
  • Phone: 929-269-3020
  • Fax: 929-333-7998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN GOELLER
Title or Position: NP/OWNER
Credential: NP
Phone: 929-269-3020