MEDICARE: DR. ELLA GELB OD

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	152W00000X	Optometrist	VUT006567	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467432195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLA GELB OD

Provider Business Mailing Address
First Line	:	3901 NOSTRAND AVE
Second Line	:	APT.6P
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2150
Country	:	US
Telephone Number	:	347-374-3167
Fax Number	:

Provider Business Practice Location Address
First Line	:	1419 SHEEPSHEAD BAY RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3813
Country	:	US
Telephone Number	:	718-934-1155
Fax Number	:	718-934-0770

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	02/19/2009

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