Healthcare Provider Details

I. General information

NPI: 1871643502
Provider Name (Legal Business Name): DR. GERALD GELDZAHLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E NORTHFIELD RD SUITE 1-C
LIVINGSTON NJ
07039-4892
US

IV. Provider business mailing address

340 E NORTHFIELD RD SUITE 1-C
LIVINGSTON NJ
07039-4892
US

V. Phone/Fax

Practice location:
  • Phone: 973-731-8844
  • Fax:
Mailing address:
  • Phone: 973-731-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD10138
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number034075-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: