Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | MD062414L | PA |
Y | 207RA0401X | Internist - Addiction Medicine | 25MA09329300 | NJ |
NPI | 1104902006 |
---|---|
Provider Name | Jeffrey Bruce Geller |
First Address | Voorhees, NJ 08043-4685 |
Second Address | Voorhees, NJ 08043-4685 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 04/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001649582 | (05) | PA |
G61687 | (02) |