Healthcare Provider Details

I. General information

NPI: 1518163419
Provider Name (Legal Business Name): LISA GELMAN-KOESSLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 MAIN ST
AMHERST NY
14226-4567
US

IV. Provider business mailing address

4575 MAIN ST
AMHERST NY
14226-4567
US

V. Phone/Fax

Practice location:
  • Phone: 716-633-4575
  • Fax: 716-633-4576
Mailing address:
  • Phone: 716-633-4575
  • Fax: 716-633-4576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number240887
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: