MEDICARE: IDEAL MEDICINE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	227347	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1043558695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL MEDICINE PC

Provider Business Mailing Address
First Line	:	2519 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4934
Country	:	US
Telephone Number	:	718-743-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2519 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4934
Country	:	US
Telephone Number	:	718-743-8900
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	DR. STELLA GELLER
Credential	:	M.D.
Telephone Number	:	718-552-5685

Provider Enumeration Date	:	01/16/2013
Last Update Date	:	01/22/2013

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Directions to “IDEAL MEDICINE PC ” Practice Location

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