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General NPI Number Information
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NPI Number | 1114330255
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Entity Type | Organization
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Legal Business Name | GOTHAM MEDICAL ASSOCIATES, PLLC
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 06/06/2014
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Provider Practice Location Address
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Address Line | 535 5TH AVE SUITE 611
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City | NEW YORK
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State | NY
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Zip | 10017-3620
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Country | US
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Telephone | 646-524-1665
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 SKYWAY DR ATTN: BARBARA LEWIS
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City | MONROE
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State | NC
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Zip | 28110-2714
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Country | US
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Telephone | 212-874-3384
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Fax | 646-873-6600
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER KIM
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Credential | MD
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Telephone | 646-524-1665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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