Healthcare Provider Details

I. General information

NPI: 1457628489
Provider Name (Legal Business Name): SHOSHANA L GELB DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MURRAY ST
NEW YORK NY
10007-2219
US

IV. Provider business mailing address

2142 UTOPIA PKWY
WHITESTONE NY
11357-4142
US

V. Phone/Fax

Practice location:
  • Phone: 212-453-4622
  • Fax: 212-453-4621
Mailing address:
  • Phone: 718-819-6803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number034489
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: