Healthcare Provider Details

I. General information

NPI: 1326066994
Provider Name (Legal Business Name): LEONARD MARK GELMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT ST
BALLSTON SPA NY
12020-1367
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD STE 203
LATHAM NY
12110-2461
US

V. Phone/Fax

Practice location:
  • Phone: 518-885-6721
  • Fax: 518-885-5412
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number166891
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: