Provider Demographics
NPI:1457503237
Name:PELZ, GEOFFREY BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:BENJAMIN
Last Name:PELZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PROSPECT AVE
Mailing Address - Street 2:HACKENSACK UNIVERSITY MEDICAL CENTER
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1914
Mailing Address - Country:US
Mailing Address - Phone:551-996-4218
Mailing Address - Fax:551-996-4833
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:HACKENSACK UNIVERSITY MEDICAL CENTER
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1914
Practice Address - Country:US
Practice Address - Phone:551-996-4218
Practice Address - Fax:551-996-4833
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432668208600000X, 208G00000X
NJ25MA09380600208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery