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General NPI Number Information
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NPI Number | 1215462205
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Entity Type | Individual
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Provider Name | MICHAEL S GOTTLIEB F.N.P-BC(ANCC) M.S.N
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Gender | Male
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 500 PECONIC ST 92A
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City | RONKONKOMA
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State | NY
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Zip | 11779-7100
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Country | US
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Telephone | 631-833-0696
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Fax | 206-350-1094
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Provider Business Mailing Address
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Address Line | 500 PECONIC ST 92A
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City | RONKONKOMA
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State | NY
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Zip | 11779-7100
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Country | US
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Telephone | 929-430-7907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F-341691
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License Number State | NY
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