Healthcare Provider Details

I. General information

NPI: 1366269003
Provider Name (Legal Business Name): RON GELMAN LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 ORVILLE DR STE 100
BOHEMIA NY
11716-2505
US

IV. Provider business mailing address

75 LA BONNE VIE DR APT D
EAST PATCHOGUE NY
11772-4352
US

V. Phone/Fax

Practice location:
  • Phone: 631-408-1124
  • Fax:
Mailing address:
  • Phone: 631-438-0457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000228
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: