Provider Demographics
NPI:1902260086
Name:SCHALLER, KATHERINE BERNAL (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BERNAL
Last Name:SCHALLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ESTRELLA
Other - Last Name:BERNAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8008 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3862
Mailing Address - Country:US
Mailing Address - Phone:718-833-3636
Mailing Address - Fax:
Practice Address - Street 1:8008 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3802
Practice Address - Country:US
Practice Address - Phone:718-833-3636
Practice Address - Fax:718-833-2432
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274005-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY274005-1OtherPHYSICIAN LICENSE