Provider Demographics
NPI:1831136795
Name:GELLMAN, ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:
Last Name:GELLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 N DEAN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2533
Mailing Address - Country:US
Mailing Address - Phone:201-503-0800
Mailing Address - Fax:201-503-1055
Practice Address - Street 1:177 N DEAN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2533
Practice Address - Country:US
Practice Address - Phone:201-503-0800
Practice Address - Fax:201-503-1055
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121153207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO8914Medicare UPIN
NY345521Medicare ID - Type Unspecified