Provider Demographics
NPI:1518163419
Name:GELMAN-KOESSLER, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GELMAN-KOESSLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4567
Mailing Address - Country:US
Mailing Address - Phone:716-633-4575
Mailing Address - Fax:716-633-4576
Practice Address - Street 1:4575 MAIN ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4567
Practice Address - Country:US
Practice Address - Phone:716-633-4575
Practice Address - Fax:716-633-4576
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240887207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000529546001OtherBC/BS
NY02899690Medicaid
NY207420CKOtherPREFERRED CARE
NY0714362OtherINDEPENDENT HEALTH
NY00028149401OtherUNIVERA
NY000529546001OtherBC/BS
NY207420CKOtherPREFERRED CARE
NYP00452117Medicare PIN