Provider Demographics
NPI:1326177262
Name:GELIEBTER, ALLAN (PHD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:GELIEBTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 WEST END AVE
Mailing Address - Street 2:3E
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5540
Mailing Address - Country:US
Mailing Address - Phone:212-308-0470
Mailing Address - Fax:212-595-1732
Practice Address - Street 1:185 WEST END AVE
Practice Address - Street 2:3E
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10023-5540
Practice Address - Country:US
Practice Address - Phone:212-308-0470
Practice Address - Fax:212-595-1732
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005608103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV23141Medicare ID - Type Unspecified