Healthcare Provider Details

I. General information

NPI: 1669639100
Provider Name (Legal Business Name): ESTHER J GOTTLIEB FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 LAUREL PARK RD
FALLSBURG NY
12733-5009
US

IV. Provider business mailing address

142 LAUREL PARK RD
FALLSBURG NY
12733-5009
US

V. Phone/Fax

Practice location:
  • Phone: 845-436-1850
  • Fax: 845-436-1851
Mailing address:
  • Phone: 845-436-1850
  • Fax: 845-436-1851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number333279
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: