Provider Demographics
NPI:1164792776
Name:STEPHEN GELLER MD PA
Entity Type:Organization
Organization Name:STEPHEN GELLER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:954-753-8010
Mailing Address - Street 1:3000 N UNIVERSITY DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5055
Mailing Address - Country:US
Mailing Address - Phone:954-753-8010
Mailing Address - Fax:954-753-9964
Practice Address - Street 1:3000 N UNIVERSITY DR
Practice Address - Street 2:SUITE G
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5055
Practice Address - Country:US
Practice Address - Phone:954-753-8010
Practice Address - Fax:954-753-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34071207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79446Medicare PIN