Healthcare Provider Details

I. General information

NPI: 1295798775
Provider Name (Legal Business Name): ALEXANDER CHARLES GELLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 POCONO RD SUITE 114
DENVILLE NJ
07834-2901
US

IV. Provider business mailing address

16 POCONO RD SUITE 114
DENVILLE NJ
07834
US

V. Phone/Fax

Practice location:
  • Phone: 973-586-3056
  • Fax: 973-625-0116
Mailing address:
  • Phone: 973-586-3056
  • Fax: 973-625-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number25MA02409000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: