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General NPI Number Information
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NPI Number | 1306399951
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Entity Type | Organization
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Legal Business Name | GOTHAM PSYCHIATRIC PC
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Dates
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Enumeration Date | 08/01/2016
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 5419 HOLLYWOOD BLVD STE C172
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City | LOS ANGELES
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State | CA
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Zip | 90027-3480
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Country | US
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Telephone | 213-814-0040
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Fax | 917-338-1381
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Provider Business Mailing Address
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Address Line | 600 N BRAND BLVD STE 640
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City | GLENDALE
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State | CA
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Zip | 91203-4215
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Country | US
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Telephone | 213-814-0040
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Fax | 917-338-1381
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL GOLDER
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Credential | MD
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Telephone | 213-814-0040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G141046
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License Number State | CA
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