Healthcare Provider Details

I. General information

NPI: 1174616767
Provider Name (Legal Business Name): LARRY ELI GELLMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 EAST SHORE ROAD SUITE 203
GREAT NECK NY
11023
US

IV. Provider business mailing address

310 EAST SHORE ROAD SUITE 203
GREAT NECK NY
11023
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-8657
  • Fax: 516-829-0002
Mailing address:
  • Phone: 516-482-8657
  • Fax: 516-829-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number190444
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: