Provider Demographics
NPI:1730493040
Name:GELLER, CORINNA M (SLP)
Entity Type:Individual
Prefix:MS
First Name:CORINNA
Middle Name:M
Last Name:GELLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:CORINNA
Other - Middle Name:MATACOTTA
Other - Last Name:GELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:36 MORRIS PKWY
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2619
Mailing Address - Country:US
Mailing Address - Phone:516-825-2518
Mailing Address - Fax:
Practice Address - Street 1:36 MORRIS PKWY
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2619
Practice Address - Country:US
Practice Address - Phone:516-825-2518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001203-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist