Healthcare Provider Details

I. General information

NPI: 1932783214
Provider Name (Legal Business Name): STEPHEN M GELL A.A.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 HOLLAND AVE APT 1E
BRONX NY
10462-2354
US

IV. Provider business mailing address

2125 HOLLAND AVE APT 1E
BRONX NY
10462-2354
US

V. Phone/Fax

Practice location:
  • Phone: 917-921-2139
  • Fax:
Mailing address:
  • Phone: 917-921-2139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number010535
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: