Provider Demographics
NPI:1518385905
Name:DANIEL GELLER PODIATRY, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DANIEL GELLER PODIATRY, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:646-645-4280
Mailing Address - Street 1:11600 WILSHIRE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1782
Mailing Address - Country:US
Mailing Address - Phone:310-395-5025
Mailing Address - Fax:888-798-0180
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 465W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2178
Practice Address - Country:US
Practice Address - Phone:310-395-5025
Practice Address - Fax:888-798-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005892213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB223126OtherMEDICARE PTAN