Healthcare Provider Details

I. General information

NPI: 1033767009
Provider Name (Legal Business Name): MARK GELFAND PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E 42ND ST
NEW YORK NY
10017-5612
US

IV. Provider business mailing address

150 E 42ND ST
NEW YORK NY
10017-5612
US

V. Phone/Fax

Practice location:
  • Phone: 212-661-8139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number065522
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: