Healthcare Provider Details

I. General information

NPI: 1922002716
Provider Name (Legal Business Name): ROBERT J GOTTLIEB DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date: 03/15/2006
Reactivation Date: 03/22/2006

III. Provider practice location address

188 W MAIN ST
OYSTER BAY NY
11771-2229
US

IV. Provider business mailing address

188 W MAIN ST
OYSTER BAY NY
11771-2229
US

V. Phone/Fax

Practice location:
  • Phone: 516-922-0502
  • Fax: 516-922-0289
Mailing address:
  • Phone: 516-922-0502
  • Fax: 516-922-0289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN002806
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: