MEDICARE: DR. HAROLD GOTTLIEB DMD

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
1	208D00000X	General Practice Physician	22781	NY

General Provider Information

NPI Number	:	1558472258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAROLD GOTTLIEB DMD

Provider Business Mailing Address
First Line	:	25618 HILLSIDE AVE
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11004-1618
Country	:	US
Telephone Number	:	718-343-5353
Fax Number	:	718-343-5354

Provider Business Practice Location Address
First Line	:	25618 HILLSIDE AVE
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11004-1618
Country	:	US
Telephone Number	:	718-343-5353
Fax Number	:	718-343-5354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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