Provider Demographics
NPI:1780788992
Name:GELLER, ERIC B (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:B
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 1:200 S ORANGE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5817
Mailing Address - Country:US
Mailing Address - Phone:973-322-7580
Mailing Address - Fax:973-322-7505
Practice Address - Street 1:200 S ORANGE AVE
Practice Address - Street 2:STE 200
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5817
Practice Address - Country:US
Practice Address - Phone:973-322-7580
Practice Address - Fax:973-322-7505
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA680102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7934807Medicaid
NJ020580P7SMedicare ID - Type Unspecified
G03319Medicare UPIN