Healthcare Provider Details

I. General information

NPI: 1457503237
Provider Name (Legal Business Name): GEOFFREY BENJAMIN PELZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE HACKENSACK UNIVERSITY MEDICAL CENTER
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

30 PROSPECT AVE HACKENSACK UNIVERSITY MEDICAL CENTER
HACKENSACK NJ
07601-1914
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-4218
  • Fax: 551-996-4833
Mailing address:
  • Phone: 551-996-4218
  • Fax: 551-996-4833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD432668
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD432668
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number25MA09380600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: