Healthcare Provider Details

I. General information

NPI: 1750778890
Provider Name (Legal Business Name): CATHERINE MAE KELSO GELLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE MAE KELSO

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 LAKEVILLE RD
NEW HYDE PARK NY
11042-1121
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST 5E-UHC
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301107374
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number309184
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number309184
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: