Provider Demographics
NPI:1730721721
Name:GELMAN, STACEY R (PA-C)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:R
Last Name:GELMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4412
Mailing Address - Country:US
Mailing Address - Phone:856-296-5207
Mailing Address - Fax:
Practice Address - Street 1:1161 NEW JERSEY 50
Practice Address - Street 2:SUITE L
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330
Practice Address - Country:US
Practice Address - Phone:609-625-7116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant