Healthcare Provider Details

I. General information

NPI: 1730721721
Provider Name (Legal Business Name): STACEY R GELMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 NEW JERSEY 50 SUITE L
MAYS LANDING NJ
08330
US

IV. Provider business mailing address

711 BRANDYWINE DR
MOORESTOWN NJ
08057-4412
US

V. Phone/Fax

Practice location:
  • Phone: 609-625-7116
  • Fax:
Mailing address:
  • Phone: 856-296-5207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00555000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: