Healthcare Provider Details

I. General information

NPI: 1871711150
Provider Name (Legal Business Name): TERRY MARTIN GELLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 BRONX RIVER RD
BRONXVILLE NY
10708-7013
US

IV. Provider business mailing address

850 BRONX RIVER RD
BRONXVILLE NY
10708-7013
US

V. Phone/Fax

Practice location:
  • Phone: 914-776-1122
  • Fax: 914-776-2410
Mailing address:
  • Phone: 914-776-1122
  • Fax: 914-776-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number032610
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: