Healthcare Provider Details

I. General information

NPI: 1245363530
Provider Name (Legal Business Name): AVRAHAM J. GOTTESMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 EASTERN PKWY
BROOKLYN NY
11213-3502
US

IV. Provider business mailing address

358 KINGSTON AVE
BROOKLYN NY
11213-4332
US

V. Phone/Fax

Practice location:
  • Phone: 718-735-6002
  • Fax: 718-735-6004
Mailing address:
  • Phone: 718-778-7272
  • Fax: 718-773-4583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number242626
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: