Healthcare Provider Details

I. General information

NPI: 1346317013
Provider Name (Legal Business Name): MATTHEW AL GELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 2ND AVE
LONG BRANCH NJ
07740-6303
US

IV. Provider business mailing address

67 MONMOUTH BLVD
OCEANPORT NJ
07757-1651
US

V. Phone/Fax

Practice location:
  • Phone: 732-923-5000
  • Fax:
Mailing address:
  • Phone: 732-259-4781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA07191600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: