Healthcare Provider Details

I. General information

NPI: 1760414528
Provider Name (Legal Business Name): HARRIS A GELBARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

PO BOX 278984
ROCHESTER NY
14627-8984
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2808
  • Fax: 585-275-3683
Mailing address:
  • Phone: 585-275-2808
  • Fax: 585-275-3683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number178553
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: