Healthcare Provider Details

I. General information

NPI: 1275583270
Provider Name (Legal Business Name): KERRY MITCHELL GELB O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161A WOODBRIDGE CTR DR
WOODBRIDGE NJ
07095-1302
US

IV. Provider business mailing address

161A WOODBRIDGE CTR DR
WOODBRIDGE NJ
07095-1302
US

V. Phone/Fax

Practice location:
  • Phone: 732-855-7950
  • Fax: 732-726-1735
Mailing address:
  • Phone: 732-855-7950
  • Fax: 732-726-1735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00451300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: