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NPI Code Detail

MEDICARE: AMY GOTTHEIMER

MEDICARE: AMY GOTTHEIMER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker079136NY

General Provider Information

NPI Number : 1043718901
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY GOTTHEIMER
Provider Business Mailing Address
First Line : 635 RIVERSIDE DR APT 3F
Second Line :
City : NEW YORK
State : NY
Zip : 10031-7154
Country : US
Telephone Number : 347-998-4206
Fax Number :
Provider Business Practice Location Address
First Line : 175 E 94TH ST APT 1
Second Line :
City : NEW YORK
State : NY
Zip : 10128-2905
Country : US
Telephone Number : 347-998-4206
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2018
Last Update Date : 06/29/2021

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