Healthcare Provider Details

I. General information

NPI: 1548261266
Provider Name (Legal Business Name): JAY DAVID GELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 ROUTE 24 SUITE B1A
CHESTER NJ
07930-2625
US

IV. Provider business mailing address

PO BOX 399
CHESTER NJ
07930-0399
US

V. Phone/Fax

Practice location:
  • Phone: 908-879-8800
  • Fax: 908-879-2955
Mailing address:
  • Phone: 908-879-8800
  • Fax: 908-879-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA05059400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number25MA05059400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: