Provider Demographics
NPI:1952591778
Name:BRADLEY D GELLER M D P A
Entity Type:Organization
Organization Name:BRADLEY D GELLER M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GELLER
Authorized Official - Suffix:
Authorized Official - Credentials:M D P A
Authorized Official - Phone:201-265-7515
Mailing Address - Street 1:466 OLD HOOK RD STE 24E
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1368
Mailing Address - Country:US
Mailing Address - Phone:201-265-7515
Mailing Address - Fax:201-265-8626
Practice Address - Street 1:466 OLD HOOK RD STE 24E
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1368
Practice Address - Country:US
Practice Address - Phone:201-265-7515
Practice Address - Fax:201-265-8626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
096755Medicare PIN