Healthcare Provider Details

I. General information

NPI: 1841379534
Provider Name (Legal Business Name): JOHN GELINAS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 NORTH ST SUITE 419
DANBURY CT
06810-5660
US

IV. Provider business mailing address

57 NORTH ST SUITE 419
DANBURY CT
06810-5660
US

V. Phone/Fax

Practice location:
  • Phone: 203-778-2020
  • Fax: 203-778-4040
Mailing address:
  • Phone: 203-778-2020
  • Fax: 203-778-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCT-033091
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number033091
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberCT-033091
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: