Provider Demographics
NPI:1700010022
Name:GELMAN, SUSAN KOREEN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KOREEN
Last Name:GELMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:KOREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7995
Mailing Address - Country:US
Mailing Address - Phone:212-604-9800
Mailing Address - Fax:
Practice Address - Street 1:20 W 13TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7995
Practice Address - Country:US
Practice Address - Phone:212-604-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121165207W00000X
NY254243207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400108554Medicare PIN
CA0A1211650Medicaid