1225028319 NPI number — AARON LEO GOTTESMAN MD

Table of content: AARON LEO GOTTESMAN MD (NPI 1225028319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225028319 NPI number — AARON LEO GOTTESMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOTTESMAN
Provider First Name:
AARON
Provider Middle Name:
LEO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225028319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 EDGEWATER ST
Provider Second Line Business Mailing Address:
6TH FL. PAYER RELATIONS
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10305-4900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-226-1008
Provider Business Mailing Address Fax Number:
718-226-1039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 SEAVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10305-3436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-226-6902
Provider Business Practice Location Address Fax Number:
718-226-6844
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  213117 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 21149183202 . This is a "BEECHSTREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 213117B11 . This is a "HEALTHFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 141437P . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2514189 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02201054 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2668751 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20811I . This is a "MAGNACARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04-07732 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 88S34 . This is a "EMPIRE BC/BS" identifier . This identifiers is of the category "OTHER".




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