Provider Demographics
NPI:1790860013
Name:DEBORAH A. GEER SURGICAL, PLLC
Entity Type:Organization
Organization Name:DEBORAH A. GEER SURGICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-252-0313
Mailing Address - Street 1:12 WATERFORD LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-9662
Mailing Address - Country:US
Mailing Address - Phone:315-252-0313
Mailing Address - Fax:
Practice Address - Street 1:12 WATERFORD LN
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-9662
Practice Address - Country:US
Practice Address - Phone:315-252-0313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238625-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
798804OtherMVP INSURANCE
P00308168OtherEXCELLUS BC/BS
NY02732621Medicaid
E76433Medicare UPIN
NYBA0856Medicare ID - Type Unspecified