Healthcare Provider Details

I. General information

NPI: 1750470050
Provider Name (Legal Business Name): JAMES R GELFAND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 STEINWAY ST
ASTORIA NY
11103-3909
US

IV. Provider business mailing address

3156 STEINWAY ST
ASTORIA NY
11103-3909
US

V. Phone/Fax

Practice location:
  • Phone: 718-721-4700
  • Fax: 718-204-5641
Mailing address:
  • Phone: 718-721-4700
  • Fax: 718-204-5641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number035887
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: