Healthcare Provider Details

I. General information

NPI: 1063851053
Provider Name (Legal Business Name): REBECCA FAITH GELIEBTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2013
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W PASSAIC ST STE 14
MAYWOOD NJ
07607-1264
US

IV. Provider business mailing address

240 W PASSAIC ST STE 14
MAYWOOD NJ
07607-1264
US

V. Phone/Fax

Practice location:
  • Phone: 201-903-0070
  • Fax: 201-322-0287
Mailing address:
  • Phone: 201-903-0070
  • Fax: 201-322-0287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number25MA10707700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: