Healthcare Provider Details

I. General information

NPI: 1720207194
Provider Name (Legal Business Name): ERIC GELFAND D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10803 LIBERTY AVE
SOUTH RICHMOND HILL NY
11419-1701
US

IV. Provider business mailing address

10803 LIBERTY AVE
SOUTH RICHMOND HILL NY
11419-1701
US

V. Phone/Fax

Practice location:
  • Phone: 718-641-5111
  • Fax:
Mailing address:
  • Phone: 718-641-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number037295
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: