Provider Demographics
NPI:1609519388
Name:GELLE, MARYAN
Entity Type:Individual
Prefix:
First Name:MARYAN
Middle Name:
Last Name:GELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MADISON AVE STE 2D
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3219
Mailing Address - Country:US
Mailing Address - Phone:607-737-6968
Mailing Address - Fax:
Practice Address - Street 1:200 MADISON AVE STE 2D
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3219
Practice Address - Country:US
Practice Address - Phone:607-737-6968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program