Healthcare Provider Details

I. General information

NPI: 1629197819
Provider Name (Legal Business Name): JAY D GELLER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 STATE ROUTE 24 SUITE B1-A
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:
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: JAY D GELLER
Title or Position: PRESIDENT
Credential: MD
Phone: 908-879-8800