Healthcare Provider Details

I. General information

NPI: 1508628132
Provider Name (Legal Business Name): MICHELLE BUNIS GELDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 ELDRIDGE ST
NEW YORK NY
10002-2924
US

IV. Provider business mailing address

135 EASTERN PKWY APT 2K
BROOKLYN NY
11238-6050
US

V. Phone/Fax

Practice location:
  • Phone: 212-453-4522
  • Fax:
Mailing address:
  • Phone: 646-715-7991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: