Basic Information
Provider Information | |||||||||
NPI: | 1467488585 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GEISLER | ||||||||
FirstName: | DANIEL | ||||||||
MiddleName: | PHILLIP | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 161 FORT WASHINGTON AVE FL 8 | ||||||||
Address2: |   | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 100323729 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2123421155 | ||||||||
FaxNumber: | 2123050267 | ||||||||
Practice Location | |||||||||
Address1: | 6550 FANNIN ST STE 1601 | ||||||||
Address2: |   | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 770302717 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7134415141 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/23/2006 | ||||||||
LastUpdateDate: | 04/20/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 291498-1 | NY | Y |   | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 360448002 | 05 | TX |   | MEDICAID | 2598336 | 05 | OH |   | MEDICAID | 360448001 | 05 | TX |   | MEDICAID | 8FZ227 | 01 | TX | BCBS | OTHER | 8FZ228 | 01 | TX | BCBS | OTHER |