Healthcare Provider Details

I. General information

NPI: 1487393625
Provider Name (Legal Business Name): ELIYA GELB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 44TH ST NW
WASHINGTON DC
20007-2001
US

IV. Provider business mailing address

1414 44TH ST NW
WASHINGTON DC
20007-2001
US

V. Phone/Fax

Practice location:
  • Phone: 202-445-3373
  • Fax:
Mailing address:
  • Phone: 202-445-3373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: