Basic Information
| Provider Information | |||||||||
| NPI: | 1033237292 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GELOFF | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 CEDAR HEIGHTS DR | ||||||||
| Address2: | |||||||||
| City: | JAMESVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154460057 | ||||||||
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| Practice Location | |||||||||
| Address1: | 961 CANAL ST | ||||||||
| Address2: | INDUSTRIAL MEDICAL ASSOCIATES | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154781977 | ||||||||
| FaxNumber: | 3154752909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0057921 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.