Provider Demographics
NPI:1619425410
Name:GOELLER, STEPHEN F JR (RN, FNP-BC, ENP-C)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:F
Last Name:GOELLER
Suffix:JR
Gender:M
Credentials:RN, FNP-BC, ENP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 E ROUTE 59 # 144
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2905
Mailing Address - Country:US
Mailing Address - Phone:929-269-3020
Mailing Address - Fax:
Practice Address - Street 1:228 E ROUTE 59 # 144
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2905
Practice Address - Country:US
Practice Address - Phone:926-269-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00712300363L00000X, 363LF0000X
CT9226363L00000X
NYF341571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner