MEDICARE: SHOSHANA L GELB DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	034489	NY

General Provider Information

NPI Number	:	1457628489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHOSHANA L GELB DPT

Provider Business Mailing Address
First Line	:	2142 UTOPIA PKWY
Second Line	:
City	:	WHITESTONE
State	:	NY
Zip	:	11357-4142
Country	:	US
Telephone Number	:	718-819-6803
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 MURRAY ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-2219
Country	:	US
Telephone Number	:	212-453-4622
Fax Number	:	212-453-4621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2011
Last Update Date	:	04/11/2016

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