Healthcare Provider Details

I. General information

NPI: 1962627406
Provider Name (Legal Business Name): MARC D GELMAN MS OTRL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 NORTHERN BLVD SUITE 103
GREAT NECK NY
11021-4058
US

IV. Provider business mailing address

55 NORTHERN BLVD SUITE 103
GREAT NECK NY
11021-4058
US

V. Phone/Fax

Practice location:
  • Phone: 516-466-9300
  • Fax: 516-466-9353
Mailing address:
  • Phone: 516-466-9300
  • Fax: 516-466-9353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number011913
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: