Provider Demographics
NPI:1508977034
Name:ROBERT H GELLER, MD SC
Entity Type:Organization
Organization Name:ROBERT H GELLER, MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-632-5600
Mailing Address - Street 1:P.O. BOX 7230
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-7230
Mailing Address - Country:US
Mailing Address - Phone:708-632-5600
Mailing Address - Fax:708-632-5602
Practice Address - Street 1:1200 S YORK STREET, SUITE 4240
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5651
Practice Address - Country:US
Practice Address - Phone:708-450-0462
Practice Address - Fax:708-632-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055119174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055119Medicaid
IL1326068677OtherNPI
IL1326068677OtherNPI
IL668500Medicare ID - Type Unspecified