Healthcare Provider Details

I. General information

NPI: 1376657940
Provider Name (Legal Business Name): EDWARD ISAAC GELBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 COURT ST 709
BROOKLYN NY
11242-0103
US

IV. Provider business mailing address

26 COURT ST 709
BROOKLYN NY
11242-0103
US

V. Phone/Fax

Practice location:
  • Phone: 917-818-3011
  • Fax: 917-768-2011
Mailing address:
  • Phone: 917-818-3011
  • Fax: 917-768-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number230381
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number282288
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101250657
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: