Provider Demographics
NPI:1548439649
Name:STAITI, ALBERT JOHN JR (RPH)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:JOHN
Last Name:STAITI
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WENDOVER RD
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2838
Mailing Address - Country:US
Mailing Address - Phone:732-233-5356
Mailing Address - Fax:
Practice Address - Street 1:2 PARAGON DR
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1718
Practice Address - Country:US
Practice Address - Phone:201-571-8226
Practice Address - Fax:201-571-8335
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01987500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01987500OtherPHARMACIST LICENSE
NY5635732OtherPHARMACIST LICENSE