Provider Demographics
NPI:1619121746
Name:GELB REJUVENATION DENTISTRY, PLLC
Entity Type:Organization
Organization Name:GELB REJUVENATION DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GELB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:212-752-1661
Mailing Address - Street 1:635 MADISON AVE
Mailing Address - Street 2:19TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1009
Mailing Address - Country:US
Mailing Address - Phone:212-752-1662
Mailing Address - Fax:
Practice Address - Street 1:635 MADISON AVE
Practice Address - Street 2:19TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1009
Practice Address - Country:US
Practice Address - Phone:212-752-1662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic