Healthcare Provider Details

I. General information

NPI: 1942307319
Provider Name (Legal Business Name): JOEL GELERNTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVENUE VA CT HEALTHCARE CENTER 116A2
WEST HAVEN CT
06516
US

IV. Provider business mailing address

11 HEMLOCK HOLLOW RD
WOODBRIDGE CT
06525-1313
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-5711
  • Fax:
Mailing address:
  • Phone: 203-932-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number029404
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: