Healthcare Provider Details

I. General information

NPI: 1497773568
Provider Name (Legal Business Name): DAVID J GELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

PO BOX 30749
STATEN ISLAND NY
10303-0749
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9175
  • Fax: 718-226-8198
Mailing address:
  • Phone: 718-947-7000
  • Fax: 718-420-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number231686
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number231686
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: