Healthcare Provider Details

I. General information

NPI: 1114097391
Provider Name (Legal Business Name): LISA J GELLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E MAIN ST
MOUNT KISCO NY
10549-3417
US

IV. Provider business mailing address

1 HEMLOCK HOLLOW RD
ARMONK NY
10504-3010
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-1254
  • Fax:
Mailing address:
  • Phone: 718-920-6626
  • Fax: 718-904-2517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number228103
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: