Healthcare Provider Details

I. General information

NPI: 1033995634
Provider Name (Legal Business Name): ALIZA REBECCA GELLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 77TH ST
NEW YORK NY
10075-1850
US

IV. Provider business mailing address

250 E 73RD ST APT 5D
NEW YORK NY
10021-4311
US

V. Phone/Fax

Practice location:
  • Phone: 617-548-0169
  • Fax:
Mailing address:
  • Phone: 617-548-0169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number034368
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: