Healthcare Provider Details

I. General information

NPI: 1023028578
Provider Name (Legal Business Name): GELLERMAN ORTHODONTICS,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 MAIN ST
HUNTINGTON NY
11743-6905
US

IV. Provider business mailing address

165 MAIN ST
HUNTINGTON NY
11743-6905
US

V. Phone/Fax

Practice location:
  • Phone: 631-427-8444
  • Fax: 631-470-7837
Mailing address:
  • Phone: 631-427-8444
  • Fax: 631-470-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number048684
License Number StateNY

VIII. Authorized Official

Name: DR. INNA GELLERMAN
Title or Position: OWNER
Credential: DDS
Phone: 631-427-8444