Healthcare Provider Details

I. General information

NPI: 1467940494
Provider Name (Legal Business Name): MS. REBECCA GELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8268 164TH ST
JAMAICA NY
11432-1121
US

IV. Provider business mailing address

25521 W END DR
GREAT NECK NY
11020-1049
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-4046
  • Fax:
Mailing address:
  • Phone: 516-582-6562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: