=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932294535
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER LEVINE GELLER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 08/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 W 51ST ST SUITE 380
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-6113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-326-5547
-----------------------------------------------------
Fax | 212-326-5549
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 27036
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10087-7036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-326-5547
-----------------------------------------------------
Fax | 212-326-5549
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 162353
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------