Healthcare Provider Details

I. General information

NPI: 1326337791
Provider Name (Legal Business Name): LUCY GELLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 TARGEE ST
STATEN ISLAND NY
10304-1926
US

IV. Provider business mailing address

958 NUGENT AVE
STATEN ISLAND NY
10306-5437
US

V. Phone/Fax

Practice location:
  • Phone: 718-390-7574
  • Fax: 718-390-5166
Mailing address:
  • Phone: 646-338-6125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number523293
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number523293
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number523293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: