Provider Demographics
NPI:1811919046
Name:GELLER, ALAN FREDERIC (DMD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:FREDERIC
Last Name:GELLER
Suffix:
Gender:M
Credentials:DMD
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 1850
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11551-1850
Mailing Address - Country:US
Mailing Address - Phone:516-572-8774
Mailing Address - Fax:516-572-6059
Practice Address - Street 1:2201 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1859
Practice Address - Country:US
Practice Address - Phone:516-572-8774
Practice Address - Fax:516-572-6059
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDF1091Medicare PIN
NYU44443Medicare UPIN