Provider Demographics
NPI:1710346382
Name:SCHALLER, ANTON
Entity Type:Individual
Prefix:
First Name:ANTON
Middle Name:
Last Name:SCHALLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1654 2ND AVE
Mailing Address - Street 2:APT 3S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-3109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1654 2ND AVE
Practice Address - Street 2:APT 3S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-3109
Practice Address - Country:US
Practice Address - Phone:201-819-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25477235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist