MEDICARE: DR. SIMONE GELMAN DDS

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	122300000X	Dentist	057515	NY

General Provider Information

NPI Number	:	1568864197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMONE GELMAN DDS

Provider Business Mailing Address
First Line	:	340 E 24TH ST
Second Line	:	APT 12L
City	:	NEW YORK
State	:	NY
Zip	:	10010-4019
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3007 FARRAGUT RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-1537
Country	:	US
Telephone Number	:	171-843-4071
Fax Number	:

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

Provider Enumeration Date	:	09/26/2014
Last Update Date	:	09/26/2014

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