Healthcare Provider Details

I. General information

NPI: 1316992811
Provider Name (Legal Business Name): ANDREW GELBMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 30TH ST
OMAHA NE
68131-2137
US

IV. Provider business mailing address

3835 S 163RD CIR
OMAHA NE
68130
US

V. Phone/Fax

Practice location:
  • Phone: 402-449-4540
  • Fax:
Mailing address:
  • Phone: 402-697-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number159
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: