Provider Demographics
NPI:1811910219
Name:GELLER, STELLA (DO)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:GELLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616D VOORHIES AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3914
Mailing Address - Country:US
Mailing Address - Phone:718-934-7960
Mailing Address - Fax:718-934-7905
Practice Address - Street 1:1616D VOORHIES AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3914
Practice Address - Country:US
Practice Address - Phone:718-934-7960
Practice Address - Fax:718-934-7905
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227347207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY74V511Medicare PIN
H91320Medicare UPIN