Healthcare Provider Details

I. General information

NPI: 1568509305
Provider Name (Legal Business Name): JUDY IRENE GELLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE ST
ENGLEWOOD NJ
07631-1808
US

IV. Provider business mailing address

1530 PALISADE AVE APT 16C
FORT LEE NJ
07024-5416
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-3163
  • Fax:
Mailing address:
  • Phone: 201-363-1934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMA065359
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: