Healthcare Provider Details

I. General information

NPI: 1447190566
Provider Name (Legal Business Name): MIRIAM GELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MIDDLETON ST
BROOKLYN NY
11206-5415
US

IV. Provider business mailing address

1607 45TH ST
BROOKLYN NY
11204-1075
US

V. Phone/Fax

Practice location:
  • Phone: 718-303-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: