Provider Demographics
NPI:1851815757
Name:GELSOMINO AND DAVIS SPEECH AND OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:GELSOMINO AND DAVIS SPEECH AND OCCUPATIONAL THERAPY
Other - Org Name:G&D SPEECH AND OCCUPATIONAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:845-747-2580
Mailing Address - Street 1:PO BOX 923
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-0923
Mailing Address - Country:US
Mailing Address - Phone:845-747-2580
Mailing Address - Fax:
Practice Address - Street 1:6113 STATE ROUTE 55
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-7626
Practice Address - Country:US
Practice Address - Phone:845-747-2580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014494-1225X00000X
NY020000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty