Healthcare Provider Details

I. General information

NPI: 1972935484
Provider Name (Legal Business Name): REUVEN GELFARB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 MORNINGSIDE AVE
NEW YORK NY
10027-4802
US

IV. Provider business mailing address

9750 QUEENS BLVD APT F8
REGO PARK NY
11374-3262
US

V. Phone/Fax

Practice location:
  • Phone: 347-537-8439
  • Fax:
Mailing address:
  • Phone: 347-537-8439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number315139
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: