Healthcare Provider Details

I. General information

NPI: 1467437764
Provider Name (Legal Business Name): DAVID SAMUEL GELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 BAINBRIDGE AVE 6TH FLOOR
BRONX NY
10467-2404
US

IV. Provider business mailing address

3400 BAINBRIDGE AVE 6TH FLOOR
BRONX NY
10467-2404
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4429
  • Fax: 718-515-4386
Mailing address:
  • Phone: 718-920-4429
  • Fax: 718-515-4386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number229471
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: