Healthcare Provider Details

I. General information

NPI: 1518638014
Provider Name (Legal Business Name): ANDREW JONATHAN GELBER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WEST 18TH STREET CELLAR
NEW YORK NY
10011
US

IV. Provider business mailing address

854 W 181ST ST APT 1H
NEW YORK NY
10033-4401
US

V. Phone/Fax

Practice location:
  • Phone: 646-678-5980
  • Fax:
Mailing address:
  • Phone: 646-240-1259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number010652-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: