Healthcare Provider Details

I. General information

NPI: 1093532954
Provider Name (Legal Business Name): GOTHAM SPINE AND BRAIN SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 11/10/2024
Certification Date: 11/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 N BROADWAY STE 204
YONKERS NY
10701-1310
US

IV. Provider business mailing address

1177 HIGH RIDGE RD STE 102
STAMFORD CT
06905-1221
US

V. Phone/Fax

Practice location:
  • Phone: 914-303-6548
  • Fax: 914-303-6435
Mailing address:
  • Phone: 917-488-8868
  • Fax: 914-303-6435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: SIMON MORR
Title or Position: PRINCIPAL
Credential: MD
Phone: 917-660-1137