Provider Demographics
NPI:1154308708
Name:SCHALLER, RICHARD J (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:SCHALLER
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 1:31 WARD DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7533
Mailing Address - Country:US
Mailing Address - Phone:908-472-3536
Mailing Address - Fax:
Practice Address - Street 1:2624 HWY 516
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2306
Practice Address - Country:US
Practice Address - Phone:732-952-5000
Practice Address - Fax:329-525-0057
Is Sole Proprietor?:No
Enumeration Date:2005-12-26
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60650207R00000X, 208100000X, 2083X0100X
PAMD4489232083P0901X
NJ25MA06065000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP621793OtherOXFORD
NJ115541400OtherFIRST HEALTH
223442762OtherFEDERAL TAX ID
NJJ027572OtherTRICARE
NJ6402500Medicaid
NJ010060511OtherRAILROAD MEDICARE
589125Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #