Provider Demographics
NPI:1609096080
Name:GEISSLER, THOMAS A (NP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:GEISSLER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 MARYLAND AVE
Mailing Address - Street 2:#1A
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2974
Mailing Address - Country:US
Mailing Address - Phone:718-556-2326
Mailing Address - Fax:
Practice Address - Street 1:412 MARYLAND AVE
Practice Address - Street 2:#1A
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2974
Practice Address - Country:US
Practice Address - Phone:718-556-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308305163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00772231OtherRAILROAD MEDICARE
NYG400001596Medicare UPIN
NYP00772231OtherRAILROAD MEDICARE