Healthcare Provider Details

I. General information

NPI: 1265526388
Provider Name (Legal Business Name): MARTIN PAUL GELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 33RD ST 15 J
NEW YORK NY
10016-9463
US

IV. Provider business mailing address

300 E 33RD ST 15 J
NEW YORK NY
10016-9463
US

V. Phone/Fax

Practice location:
  • Phone: 212-679-6976
  • Fax: 212-562-4973
Mailing address:
  • Phone: 212-679-6976
  • Fax: 212-562-4973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number093765
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: