Provider Demographics
NPI:1720094840
Name:GEIS, EDWARD ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ANTHONY
Last Name:GEIS
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 1:142 CASTLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3200
Mailing Address - Country:US
Mailing Address - Phone:516-627-9430
Mailing Address - Fax:
Practice Address - Street 1:34 PLAZA ST E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5038
Practice Address - Country:US
Practice Address - Phone:718-638-2700
Practice Address - Fax:718-638-3271
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132230174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist