Healthcare Provider Details

I. General information

NPI: 1255490488
Provider Name (Legal Business Name): TOBY ALAN GELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 DUNHAMS CORNER RD
EAST BRUNSWICK NJ
08816-3532
US

IV. Provider business mailing address

PO BOX 95000
PHILADELPHIA PA
19195-7550
US

V. Phone/Fax

Practice location:
  • Phone: 732-254-3300
  • Fax: 732-651-0822
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA03185900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: