Healthcare Provider Details

I. General information

NPI: 1720063001
Provider Name (Legal Business Name): BRUCE GELB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL BOX 1201
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL BOX 1201
NEW YORK NY
10029-6500
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-8662
  • Fax: 212-534-2659
Mailing address:
  • Phone: 212-241-8662
  • Fax: 212-534-2659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number160021
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number160021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: