Provider Demographics
NPI:1659122182
Name:GELLMAN, JUSTIN DANIEL (BS)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:DANIEL
Last Name:GELLMAN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 N 36TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5639
Mailing Address - Country:US
Mailing Address - Phone:314-605-9889
Mailing Address - Fax:
Practice Address - Street 1:1050 N HANCOCK ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-2342
Practice Address - Country:US
Practice Address - Phone:314-605-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program