Provider Demographics
NPI:1902820178
Name:STANISLAUS, GALEN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:GALEN
Middle Name:PAUL
Last Name:STANISLAUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BEAR OAK RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-9311
Mailing Address - Country:US
Mailing Address - Phone:732-863-6708
Mailing Address - Fax:
Practice Address - Street 1:112 BEAR OAK RD
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-9311
Practice Address - Country:US
Practice Address - Phone:732-863-6708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04211100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine