| Stall Senior Medical Llc | |
|
4242 Ridge Lea Rd Ste 26 Amherst NY 14226 | |
| (716) 833-3237 | |
| (888) 976-5853 |
| Full Name | Stall Senior Medical Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4242 Ridge Lea Rd Ste 26, Amherst, New York |
| Authorized Official Name and Position | Robert Stall (CEO) |
| Authorized Official Contact | 7168333237 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stall Senior Medical Llc 4242 Ridge Lea Rd Ste 26 Amherst NY 14226-5120 Ph: (716) 833-3237 | Stall Senior Medical Llc 4242 Ridge Lea Rd Ste 26 Amherst NY 14226 Ph: (716) 833-3237 |
| NPI Number | 1104087915 |
|---|---|
| Provider Enumeration Date | 06/24/2008 |
| Last Update Date | 08/17/2018 |
| Medicare PECOS PAC ID | 2365515384 |
|---|---|
| Medicare Enrollment ID | O20080723000652 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104087915 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | 163872 (New York) | Primary |
| Provider Name | Robert S Stall |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1205822202 PECOS PAC ID: 5496834343 Enrollment ID: I20080505000367 |
| Provider Name | Keith Levine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548677461 PECOS PAC ID: 6901120831 Enrollment ID: I20150123000557 |
| Provider Name | Katherine E Flower |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821360330 PECOS PAC ID: 3173835162 Enrollment ID: I20150706000534 |
| Provider Name | Rachel R Ludwig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528208675 PECOS PAC ID: 3072812627 Enrollment ID: I20160503000770 |
| Provider Name | Nicole Barrett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770035503 PECOS PAC ID: 4486930476 Enrollment ID: I20170405001209 |
| Provider Name | Anna Catherine Marszalkowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093340465 PECOS PAC ID: 5395156194 Enrollment ID: I20201130002992 |
| Provider Name | David Michael Armstrong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962048793 PECOS PAC ID: 8820405376 Enrollment ID: I20210329001906 |
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