Healthcare Provider Details

I. General information

NPI: 1245790716
Provider Name (Legal Business Name): LEE SOLOMON GOTTESDIENER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 YORK AVE
NEW YORK NY
10021-5304
US

IV. Provider business mailing address

505 E 70TH ST
NEW YORK NY
10021-4872
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-8747
  • Fax: 646-962-0152
Mailing address:
  • Phone: 212-746-9663
  • Fax: 212-746-3609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number333213
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: