Provider Demographics
NPI:1548261266
Name:GELLER, JAY DAVID (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:DAVID
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:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-0399
Mailing Address - Country:US
Mailing Address - Phone:908-879-8800
Mailing Address - Fax:908-879-2955
Practice Address - Street 1:310 ROUTE 24
Practice Address - Street 2:SUITE B1A
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2625
Practice Address - Country:US
Practice Address - Phone:908-879-8800
Practice Address - Fax:908-879-2955
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05059400207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223167652OtherTAXPAYER I.D.
NJ5083401Medicaid
NJ5083401Medicaid
NJF07156Medicare UPIN