Healthcare Provider Details

I. General information

NPI: 1114330255
Provider Name (Legal Business Name): GOTHAM MEDICAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 5TH AVE SUITE 611
NEW YORK NY
10017-3620
US

IV. Provider business mailing address

1801 SKYWAY DR ATTN: BARBARA LEWIS
MONROE NC
28110-2714
US

V. Phone/Fax

Practice location:
  • Phone: 646-524-1665
  • Fax:
Mailing address:
  • Phone: 212-874-3384
  • Fax: 646-873-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER KIM
Title or Position: OWNER
Credential: MD
Phone: 646-524-1665