Healthcare Provider Details

I. General information

NPI: 1407484538
Provider Name (Legal Business Name): LISA GELLER PT, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MADISON AVE
MORRISTOWN NJ
07960-6097
US

IV. Provider business mailing address

111 MADISON AVE
MORRISTOWN NJ
07960-6097
US

V. Phone/Fax

Practice location:
  • Phone: 973-683-2360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number40QA85700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: