Healthcare Provider Details

I. General information

NPI: 1780607580
Provider Name (Legal Business Name): BRADLEY DAVID GELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 OLD HOOK RD SUITE 24E
EMERSON NJ
07630-1396
US

IV. Provider business mailing address

466 OLD HOOK RD SUITE 24E
EMERSON NJ
07630-1396
US

V. Phone/Fax

Practice location:
  • Phone: 201-265-7515
  • Fax: 201-265-8626
Mailing address:
  • Phone: 201-265-7515
  • Fax: 201-265-8626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA07936700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: