Healthcare Provider Details

I. General information

NPI: 1487986485
Provider Name (Legal Business Name): MARC DAVID GELLER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 EAST MAIN STREET
SOMERVILLE NJ
08876-3109
US

IV. Provider business mailing address

337 EAST MAIN STREET
SOMERVILLE NJ
08876-3109
US

V. Phone/Fax

Practice location:
  • Phone: 908-725-9090
  • Fax: 908-725-9112
Mailing address:
  • Phone: 908-725-9090
  • Fax: 908-725-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00182100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: