Provider Demographics
NPI:1508804238
Name:GEYER, ADAM SHAKER (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:SHAKER
Last Name:GEYER
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 1:505 GREENWICH ST
Mailing Address - Street 2:12B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-1380
Mailing Address - Country:US
Mailing Address - Phone:917-733-1625
Mailing Address - Fax:
Practice Address - Street 1:30-32 ERICSSON PLACE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-6301
Practice Address - Country:US
Practice Address - Phone:212-374-9750
Practice Address - Fax:212-374-9705
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223986207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02638631Medicaid
NYI23457Medicare UPIN
NYA400001285Medicare PIN