Provider Demographics
NPI:1609015403
Name:ANDREW LEE GELLER, C.S.W., P.C.
Entity Type:Organization
Organization Name:ANDREW LEE GELLER, C.S.W., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-806-7532
Mailing Address - Street 1:515 E 85TH ST
Mailing Address - Street 2:6B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7421
Mailing Address - Country:US
Mailing Address - Phone:917-806-7532
Mailing Address - Fax:
Practice Address - Street 1:312 W 34TH ST
Practice Address - Street 2:PENTHOUSE A-3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2401
Practice Address - Country:US
Practice Address - Phone:212-947-7111
Practice Address - Fax:212-239-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040501-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN4H641Medicaid