Healthcare Provider Details

I. General information

NPI: 1265862742
Provider Name (Legal Business Name): NEIL GELERTER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 CLIFTON AVE
CLIFTON NJ
07011-1916
US

IV. Provider business mailing address

234 CLIFTON AVE
CLIFTON NJ
07011-1916
US

V. Phone/Fax

Practice location:
  • Phone: 973-340-1988
  • Fax:
Mailing address:
  • Phone: 973-340-1988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI01624000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: