Healthcare Provider Details

I. General information

NPI: 1619121746
Provider Name (Legal Business Name): GELB REJUVENATION DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 MADISON AVE 19TH FLOOR
NEW YORK NY
10022-1009
US

IV. Provider business mailing address

635 MADISON AVE 19TH FLOOR
NEW YORK NY
10022-1009
US

V. Phone/Fax

Practice location:
  • Phone: 212-752-1662
  • Fax:
Mailing address:
  • Phone: 212-752-1662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL GELB
Title or Position: PROPRIETOR
Credential: D.D.S., M.S.
Phone: 212-752-1661