Healthcare Provider Details

I. General information

NPI: 1811607948
Provider Name (Legal Business Name): ALICIA GELUSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 11/30/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 OAKCREST AVE
FARMINGVILLE NY
11738-1921
US

IV. Provider business mailing address

21 OAKCREST AVE
FARMINGVILLE NY
11738-1921
US

V. Phone/Fax

Practice location:
  • Phone: 631-312-6998
  • Fax:
Mailing address:
  • Phone: 631-312-6998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number009139
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: