Provider Demographics
NPI:1962777649
Name:PETER S GELFAND D O P C
Entity type:Organization
Organization Name:PETER S GELFAND D O P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:GELFAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-432-0203
Mailing Address - Street 1:718 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2605
Mailing Address - Country:US
Mailing Address - Phone:516-432-0203
Mailing Address - Fax:516-432-3073
Practice Address - Street 1:718 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2605
Practice Address - Country:US
Practice Address - Phone:516-432-0203
Practice Address - Fax:516-432-3073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01751106Medicaid
NY00384134Medicaid
NYG21044Medicare UPIN
NY00384134Medicaid