Healthcare Provider Details

I. General information

NPI: 1578095584
Provider Name (Legal Business Name): JARED GELBS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

IV. Provider business mailing address

118 HILLCREST PARK RD
COS COB CT
06807-1901
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2332
  • Fax: 718-515-5426
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number303970
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number303970
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: