Healthcare Provider Details

I. General information

NPI: 1043339088
Provider Name (Legal Business Name): RANDY RYAN GELLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 BELLMORE AVE
BELLMORE NY
11710-5606
US

IV. Provider business mailing address

2140 BELLMORE AVE
BELLMORE NY
11710-5606
US

V. Phone/Fax

Practice location:
  • Phone: 516-785-4744
  • Fax: 516-785-4790
Mailing address:
  • Phone: 516-785-4744
  • Fax: 516-785-4790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number048820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: