Healthcare Provider Details

I. General information

NPI: 1124308937
Provider Name (Legal Business Name): CYNTHIA JEAN GEHLBACH R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ROBERTS ST
FARMINGDALE NY
11735-5131
US

IV. Provider business mailing address

206 WILLARD AVE
FARMINGDALE NY
11735-5131
US

V. Phone/Fax

Practice location:
  • Phone: 516-293-0051
  • Fax:
Mailing address:
  • Phone: 516-249-9810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number303501-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: