Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 22DI01126000 | NJ |
NPI | 1093861940 |
---|---|
Provider Name | Dr. Mark Joel Gelband |
First Address | Red Bank, NJ 07701-1732 |
Second Address | Red Bank, NJ 07701-1732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 08/07/2007 |