Provider Demographics
NPI:1275583270
Name:GELB, KERRY MITCHELL (OD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:MITCHELL
Last Name:GELB
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161A WOODBRIDGE CTR DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1302
Mailing Address - Country:US
Mailing Address - Phone:732-855-7950
Mailing Address - Fax:732-726-1735
Practice Address - Street 1:161A WOODBRIDGE CTR DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1302
Practice Address - Country:US
Practice Address - Phone:732-855-7950
Practice Address - Fax:732-726-1735
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00451300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU27458Medicare UPIN
NJ707619DEEMedicare ID - Type Unspecified