Healthcare Provider Details

I. General information

NPI: 1255314001
Provider Name (Legal Business Name): DOUGLAS GELLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 AMWELL RD
HILLSBOROUGH NJ
08844-1210
US

IV. Provider business mailing address

311 AMWELL RD
HILLSBOROUGH NJ
08844-1210
US

V. Phone/Fax

Practice location:
  • Phone: 908-281-9002
  • Fax:
Mailing address:
  • Phone: 908-281-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00147900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: