Provider Demographics
NPI:1659705317
Name:GELLER, NAOMI PAMELA (MS)
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:PAMELA
Last Name:GELLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 CHANNING RD
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4712
Mailing Address - Country:US
Mailing Address - Phone:646-591-7039
Mailing Address - Fax:
Practice Address - Street 1:1217 CHANNING RD
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4712
Practice Address - Country:US
Practice Address - Phone:646-591-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor