Healthcare Provider Details

I. General information

NPI: 1710145396
Provider Name (Legal Business Name): RUTH E GELLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLY PL
BROOKLYN NY
11209-7104
US

IV. Provider business mailing address

800 POLY PL
BROOKLYN NY
11209-7104
US

V. Phone/Fax

Practice location:
  • Phone: 585-313-3495
  • Fax:
Mailing address:
  • Phone: 585-313-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number245765
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: