Healthcare Provider Details

I. General information

NPI: 1932557246
Provider Name (Legal Business Name): JENNIFER GELINAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W 86TH ST
NEW YORK NY
10024-3671
US

IV. Provider business mailing address

710 W 168TH ST
NEW YORK NY
10032-3726
US

V. Phone/Fax

Practice location:
  • Phone: 646-426-3876
  • Fax:
Mailing address:
  • Phone: 646-426-3876
  • Fax: 212-305-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number289018
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: