Provider Demographics
NPI:1619207172
Name:GELBFISH, MATTIE E (PA)
Entity Type:Individual
Prefix:MRS
First Name:MATTIE
Middle Name:E
Last Name:GELBFISH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9201 4TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7006
Mailing Address - Country:US
Mailing Address - Phone:718-748-1234
Mailing Address - Fax:718-748-4253
Practice Address - Street 1:9201 4TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7006
Practice Address - Country:US
Practice Address - Phone:718-748-1234
Practice Address - Fax:718-748-4253
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006749363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant