Provider Demographics
NPI:1679568018
Name:GELFOND, NINA (OD)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:GELFOND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2500
Mailing Address - Country:US
Mailing Address - Phone:716-896-8831
Mailing Address - Fax:716-896-2318
Practice Address - Street 1:4590 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14226-4548
Practice Address - Country:US
Practice Address - Phone:716-893-3535
Practice Address - Fax:716-896-2318
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006325152W00000X
NYUVT006325-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD882602-01OtherBCBS
MD7512500OtherAETNA
MDS017-0013OtherBLUE CHOICE
MD1284085OtherAETNA
MD2493649OtherUNITED HC
MD7512500OtherAETNA
MDS017-0013OtherBLUE CHOICE
MD4091880004Medicare NSC