Provider Demographics
NPI:1093726952
Name:GELIA, MAURICE M (DPM)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:M
Last Name:GELIA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1540 ELLICOTT CREEK RD
Mailing Address - Street 2:STE 1
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-2935
Mailing Address - Country:US
Mailing Address - Phone:716-743-2000
Mailing Address - Fax:716-743-2002
Practice Address - Street 1:1540 ELLICOTT CREEK RD
Practice Address - Street 2:STE 1
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-2935
Practice Address - Country:US
Practice Address - Phone:716-743-2000
Practice Address - Fax:716-743-2002
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3641-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01113157Medicaid
NY1093726952OtherNATIONAL PROVIDER IDENTIFIER
NY480004594OtherMEDICARE RAILROAD
NY0976280001Medicare NSC
NY01113157Medicaid
NY480004594OtherMEDICARE RAILROAD