Provider Demographics
NPI:1750683579
Name:CHARLES L GELLIDO MD LLC
Entity Type:Organization
Organization Name:CHARLES L GELLIDO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GELLIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-686-7881
Mailing Address - Street 1:2137 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6002
Mailing Address - Country:US
Mailing Address - Phone:908-686-7881
Mailing Address - Fax:908-686-7889
Practice Address - Street 1:2137 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6002
Practice Address - Country:US
Practice Address - Phone:908-686-7881
Practice Address - Fax:908-686-7889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069939002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02179353Medicaid
NJ068883OtherMEDICARE
H53318Medicare UPIN