Healthcare Provider Details

I. General information

NPI: 1740492560
Provider Name (Legal Business Name): LAWRENCE B GELB D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 64TH ST APT 26A
NEW YORK NY
10065-7548
US

IV. Provider business mailing address

300 E 64TH ST APT 26A
NEW YORK NY
10065-7548
US

V. Phone/Fax

Practice location:
  • Phone: 203-610-1756
  • Fax:
Mailing address:
  • Phone: 203-610-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number4752
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number031064
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: