Healthcare Provider Details

I. General information

NPI: 1326364662
Provider Name (Legal Business Name): ELLYN GELLER ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4475 ROUTE 27
KINGSTON NJ
08528-9601
US

IV. Provider business mailing address

4475 ROUTE 27
KINGSTON NJ
08528-9601
US

V. Phone/Fax

Practice location:
  • Phone: 609-921-1334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1807
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: