Healthcare Provider Details

I. General information

NPI: 1780869040
Provider Name (Legal Business Name): SHARLENE L GEYER PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKDALE PLAZA
BROOKLYN NY
11212
US

IV. Provider business mailing address

1 BROOKDALE PLAZA
BROOKLYN NY
11212
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-5000
  • Fax:
Mailing address:
  • Phone: 718-240-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0013081
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: