Provider Demographics
NPI:1568431609
Name:GELLER, DANA (MS PT DPT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:GELLER
Suffix:
Gender:F
Credentials:MS PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HILLS STATION RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-3725
Mailing Address - Country:US
Mailing Address - Phone:917-846-4907
Mailing Address - Fax:
Practice Address - Street 1:130 HILLS STATION RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-3725
Practice Address - Country:US
Practice Address - Phone:917-846-4907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013912-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3613561OtherOXFORD ID NUMBER
NYQ22R21Medicare ID - Type UnspecifiedPROVIDER ID NUMBER