Provider Demographics
NPI:1902867955
Name:GEISLER, WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:
Last Name:GEISLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 WILLIAMSBRIDGE RD
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6265
Mailing Address - Country:US
Mailing Address - Phone:718-863-8465
Mailing Address - Fax:718-863-8983
Practice Address - Street 1:1578 WILLIAMSBRIDGE RD
Practice Address - Street 2:SUITE 2D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6265
Practice Address - Country:US
Practice Address - Phone:718-863-8465
Practice Address - Fax:718-863-8983
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184047207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01571668Medicaid
NYA400012345OtherGROUP MEMBER PTAN
NY01571668Medicaid