Healthcare Provider Details

I. General information

NPI: 1023829322
Provider Name (Legal Business Name): MICHAEL GELLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 ROLLINGWOOD DR
NEW CITY NY
10956-2006
US

IV. Provider business mailing address

14 ROLLINGWOOD DR
NEW CITY NY
10956-2006
US

V. Phone/Fax

Practice location:
  • Phone: 845-521-5515
  • Fax:
Mailing address:
  • Phone: 845-521-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number125996-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: