Healthcare Provider Details

I. General information

NPI: 1518434711
Provider Name (Legal Business Name): ZACHARY GELLER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 BROADWAY RM 603
NEW YORK NY
10012-3257
US

IV. Provider business mailing address

350 LINCOLN PL APT 4L
BROOKLYN NY
11238-5843
US

V. Phone/Fax

Practice location:
  • Phone: 917-338-1402
  • Fax:
Mailing address:
  • Phone: 718-696-8449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number022981
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: