Provider Demographics
NPI:1679643779
Name:GELFAND, BRYAN JEREMY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JEREMY
Last Name:GELFAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4477
Mailing Address - Country:US
Mailing Address - Phone:732-747-7730
Mailing Address - Fax:732-747-7976
Practice Address - Street 1:23 WHITE ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4477
Practice Address - Country:US
Practice Address - Phone:732-747-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0241900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ461532702OtherTIN