Provider Demographics
NPI:1659359149
Name:GELLMAN, WENDY (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:GELLMAN
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 1:4711 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4888
Mailing Address - Country:US
Mailing Address - Phone:716-668-5331
Mailing Address - Fax:716-668-5370
Practice Address - Street 1:4711 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14043-4888
Practice Address - Country:US
Practice Address - Phone:716-668-5331
Practice Address - Fax:716-668-5370
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200804208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1209762OtherIHA
NY01772045Medicaid
NY000524991004OtherBC/BS
NY00010307103OtherUNIVERA
NY040426002408OtherFIDELIS
NY146559DLOtherPREFERRED CARE
G58245Medicare UPIN
NY146559DLOtherPREFERRED CARE