Provider Demographics
NPI:1033752134
Name:GELLER, JANNA
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:GELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-1603
Mailing Address - Country:US
Mailing Address - Phone:201-768-7272
Mailing Address - Fax:201-750-1136
Practice Address - Street 1:45 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DEMAREST
Practice Address - State:NJ
Practice Address - Zip Code:07627-1603
Practice Address - Country:US
Practice Address - Phone:201-768-7272
Practice Address - Fax:201-750-1136
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NJ41YS00248300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist