Healthcare Provider Details

I. General information

NPI: 1205945409
Provider Name (Legal Business Name): FRIEDRICH BOETTNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 212-774-2127
  • Fax: 212-861-7044
Mailing address:
  • Phone: 212-774-2127
  • Fax: 212-774-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number253920
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: