Healthcare Provider Details

I. General information

NPI: 1447299128
Provider Name (Legal Business Name): ALAN JAY GELLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17903 LINDEN BLVD
JAMAICA NY
11434-1428
US

IV. Provider business mailing address

280 GUY LOMBARDO AVE APT 5E
FREEPORT NY
11520-4955
US

V. Phone/Fax

Practice location:
  • Phone: 718-526-1000
  • Fax:
Mailing address:
  • Phone: 718-526-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number030386-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: