Healthcare Provider Details

I. General information

NPI: 1891141560
Provider Name (Legal Business Name): MATTHEW GOTLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 E 74TH ST
NEW YORK NY
10021-3235
US

IV. Provider business mailing address

2 OVERHILL RD STE 310
SCARSDALE NY
10583-5316
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-3301
  • Fax:
Mailing address:
  • Phone: 212-737-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number304152
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: