Healthcare Provider Details

I. General information

NPI: 1043977549
Provider Name (Legal Business Name): EDWARD GELBINOVICH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date: 03/04/2022
Reactivation Date: 06/27/2022

III. Provider practice location address

10200 NW 25TH ST STE A-108
DORAL FL
33172-5921
US

IV. Provider business mailing address

924 PAWSTAND RD
CELEBRATION FL
34747-4856
US

V. Phone/Fax

Practice location:
  • Phone: 786-717-5649
  • Fax:
Mailing address:
  • Phone: 646-872-2631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: