Provider Demographics
NPI:1407268212
Name:GELLIS- GOTTLIEB, ESTHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:
Last Name:GELLIS- GOTTLIEB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2617
Mailing Address - Country:US
Mailing Address - Phone:516-569-4130
Mailing Address - Fax:
Practice Address - Street 1:96 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3461
Practice Address - Country:US
Practice Address - Phone:516-792-6952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0580441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice