Healthcare Provider Details

I. General information

NPI: 1619207172
Provider Name (Legal Business Name): MATTIE E GELBFISH P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 4TH AVE FL 2
BROOKLYN NY
11209-7006
US

IV. Provider business mailing address

9201 4TH AVE FL 2
BROOKLYN NY
11209-7006
US

V. Phone/Fax

Practice location:
  • Phone: 718-748-1234
  • Fax: 718-748-4253
Mailing address:
  • Phone: 718-748-1234
  • Fax: 718-748-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006749
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: