Healthcare Provider Details

I. General information

NPI: 1841454451
Provider Name (Legal Business Name): ALLA GELLER MS,CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2008
Last Update Date: 07/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SHORE PKWY UNIT 2K
BROOKLYN NY
11214-7240
US

IV. Provider business mailing address

2121 SHORE PKWY UNIT 2K
BROOKLYN NY
11214-7240
US

V. Phone/Fax

Practice location:
  • Phone: 917-647-2791
  • Fax: 718-266-0287
Mailing address:
  • Phone: 917-647-2791
  • Fax: 718-266-0287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number004634
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: