Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 048684-1 | NY |
N | 1223X0400X | Orthodontists | DI02165200 | NJ |
N | 1223X0400X | Orthodontists | DI02165201 | NJ |
NPI | 1053412387 |
---|---|
Provider Name | Inna Gellerman |
First Address | Huntington, NY 11743-3570 |
Second Address | Huntington, NY 11743-3570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 29/06/2009 |