Healthcare Provider Details

I. General information

NPI: 1285828327
Provider Name (Legal Business Name): DEBORAH L GORTLER D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 WOODSIDE AVE
BRIARCLIFF MANOR NY
10510-1461
US

IV. Provider business mailing address

127 WOODSIDE AVE
BRIARCLIFF MANOR NY
10510-1461
US

V. Phone/Fax

Practice location:
  • Phone: 914-962-2001
  • Fax:
Mailing address:
  • Phone: 914-962-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number054313
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number22DI02357400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number054313-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: