Healthcare Provider Details

I. General information

NPI: 1083306567
Provider Name (Legal Business Name): JACQUELINE C GELBART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W COLUMBIA ST
HEMPSTEAD NY
11550-2411
US

IV. Provider business mailing address

724 BRIX PL
UNIONDALE NY
11553-3076
US

V. Phone/Fax

Practice location:
  • Phone: 516-654-8600
  • Fax:
Mailing address:
  • Phone: 516-851-4146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: