1770773129 NPI number — PETER MARK GELLER L.AC., R.AC.

Table of content: PETER MARK GELLER L.AC., R.AC. (NPI 1770773129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770773129 NPI number — PETER MARK GELLER L.AC., R.AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GELLER
Provider First Name:
PETER
Provider Middle Name:
MARK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.AC., R.AC.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770773129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3686 LYNNFIELD RD
Provider Second Line Business Mailing Address:
DOWN
Provider Business Mailing Address City Name:
SHAKER HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-5112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-275-2716
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8398 KINSMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOVELTY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44072-9577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-338-6344
Provider Business Practice Location Address Fax Number:
440-338-6355
Provider Enumeration Date:
07/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  91 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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