MEDICARE: DANA GELLER MS PT DPT

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	174400000X	Specialist	013912-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P3613561	OTHER	NY	OXFORD ID NUMBER

General Provider Information

NPI Number	:	1568431609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA GELLER MS PT DPT

Provider Business Mailing Address
First Line	:	130 HILLS STATION RD
Second Line	:
City	:	SOUTHAMPTON
State	:	NY
Zip	:	11968-3725
Country	:	US
Telephone Number	:	917-846-4907
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 HILLS STATION RD
Second Line	:
City	:	SOUTHAMPTON
State	:	NY
Zip	:	11968-3725
Country	:	US
Telephone Number	:	917-846-4907
Fax Number	:

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	01/28/2010

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