Healthcare Provider Details

I. General information

NPI: 1407132020
Provider Name (Legal Business Name): GELLER HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CHICAGO AVE
STATEN ISLAND NY
10305-3757
US

IV. Provider business mailing address

180 TRANTOR PL 3C
STATEN ISLAND NY
10302-1959
US

V. Phone/Fax

Practice location:
  • Phone: 718-448-7828
  • Fax:
Mailing address:
  • Phone: 917-324-5015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number592180
License Number StateNY

VIII. Authorized Official

Name: BERYL KENDE
Title or Position: DIRECTOR
Credential:
Phone: 718-442-7828