Healthcare Provider Details

I. General information

NPI: 1700010022
Provider Name (Legal Business Name): SUSAN KOREEN GELMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN KOREEN

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W 13TH ST
NEW YORK NY
10011-7995
US

IV. Provider business mailing address

20 W 13TH ST
NEW YORK NY
10011-7995
US

V. Phone/Fax

Practice location:
  • Phone: 212-604-9800
  • Fax:
Mailing address:
  • Phone: 212-604-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA121165
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number254243
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: