Healthcare Provider Details

I. General information

NPI: 1073696084
Provider Name (Legal Business Name): MICHAEL GELB DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 MADISON AVE 19TH FLOOR
NEW YORK NY
10022
US

IV. Provider business mailing address

635 MADISON AVE 19TH FLOOR
NEW YORK NY
10022
US

V. Phone/Fax

Practice location:
  • Phone: 212-752-1661
  • Fax: 212-832-5904
Mailing address:
  • Phone: 212-752-1661
  • Fax: 212-832-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number037444
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: