Healthcare Provider Details

I. General information

NPI: 1720254196
Provider Name (Legal Business Name): ALAN M GELLER R.P.A-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 RIVERSIDE DR
JOHNSON CITY NY
13790-2742
US

IV. Provider business mailing address

221 LEROY ST
BINGHAMTON NY
13905-4033
US

V. Phone/Fax

Practice location:
  • Phone: 607-770-9050
  • Fax: 607-770-9051
Mailing address:
  • Phone: 607-770-9050
  • Fax: 607-770-9051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: