Provider Demographics
NPI:1932294535
Name:GELLER, PETER LEVINE (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:LEVINE
Last Name:GELLER
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:PO BOX 27036
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7036
Mailing Address - Country:US
Mailing Address - Phone:212-326-5547
Mailing Address - Fax:212-326-5549
Practice Address - Street 1:51 W 51ST ST
Practice Address - Street 2:SUITE 380
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6113
Practice Address - Country:US
Practice Address - Phone:212-326-5547
Practice Address - Fax:212-326-5549
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162353208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01043549Medicaid
NY98D151Medicare ID - Type Unspecified
NY01043549Medicaid