Provider Demographics
NPI:1558375329
Name:GELLER, BRIAN STEWART (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:STEWART
Last Name:GELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:496 SMITHTOWN BYP
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5005
Mailing Address - Country:US
Mailing Address - Phone:631-979-8880
Mailing Address - Fax:631-979-8064
Practice Address - Street 1:496 SMITHTOWN BYP
Practice Address - Street 2:SUITE 101
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5005
Practice Address - Country:US
Practice Address - Phone:631-979-8880
Practice Address - Fax:631-979-8064
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY150263207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01357813Medicaid
NY01357813Medicaid
NY33E911Medicare ID - Type Unspecified