Provider Demographics
NPI:1487998084
Name:GELVELES, THOMAS D
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:GELVELES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 WAVERLY AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1597
Mailing Address - Country:US
Mailing Address - Phone:631-758-5700
Mailing Address - Fax:631-758-7005
Practice Address - Street 1:4405 WAVERLY AVE STE 5
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-758-5700
Practice Address - Fax:631-758-7005
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017433-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist