Healthcare Provider Details

I. General information

NPI: 1366447971
Provider Name (Legal Business Name): SCOTT GOTTESFELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BEDFORD RD CARE MOUNT MEDICAL PC
KATONAH NY
10536-2115
US

IV. Provider business mailing address

110 S BEDFORD RD CARE MOUNT MEDICAL PC
MOUNT KISCO NY
10549-3446
US

V. Phone/Fax

Practice location:
  • Phone: 914-232-3135
  • Fax: 914-242-1516
Mailing address:
  • Phone: 914-241-1050
  • Fax: 914-242-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number214602
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: