Provider Demographics
NPI:1780607580
Name:GELLER, BRADLEY DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:DAVID
Last Name:GELLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:466 OLD HOOK RD
Mailing Address - Street 2:SUITE 24E
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1396
Mailing Address - Country:US
Mailing Address - Phone:201-265-7515
Mailing Address - Fax:201-265-8626
Practice Address - Street 1:466 OLD HOOK RD
Practice Address - Street 2:SUITE 24E
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1396
Practice Address - Country:US
Practice Address - Phone:201-265-7515
Practice Address - Fax:201-265-8626
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07936700207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH58871Medicare UPIN
NJ096756UU6Medicare PIN