Healthcare Provider Details

I. General information

NPI: 1073908372
Provider Name (Legal Business Name): ADAM GELB CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 02/15/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR DEPT OF ANESTHESIA
MANHASSET NY
11030-3816
US

IV. Provider business mailing address

300 COMMUNITY DR
MANHASSET NY
11030-3816
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-4887
  • Fax:
Mailing address:
  • Phone: 516-562-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number698499
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: