MEDICARE: DR. ZACHARY GELLER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	022981	NY

General Provider Information

NPI Number	:	1518434711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZACHARY GELLER PHD

Provider Business Mailing Address
First Line	:	350 LINCOLN PL APT 4L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-5843
Country	:	US
Telephone Number	:	718-696-8449
Fax Number	:

Provider Business Practice Location Address
First Line	:	594 BROADWAY RM 603
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10012-3257
Country	:	US
Telephone Number	:	917-338-1402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2018
Last Update Date	:	10/26/2018

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