Provider Demographics
NPI:1285996892
Name:GELLER, ELLICE (BS, MA, SAS)
Entity type:Individual
Prefix:MS
First Name:ELLICE
Middle Name:
Last Name:GELLER
Suffix:
Gender:F
Credentials:BS, MA, SAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FIRWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1510
Mailing Address - Country:US
Mailing Address - Phone:516-944-2208
Mailing Address - Fax:516-944-2208
Practice Address - Street 1:16 FIRWOOD RD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-1510
Practice Address - Country:US
Practice Address - Phone:516-944-2208
Practice Address - Fax:516-944-2208
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist