=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740494301
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAN C GOTTESMANN PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 NOTTINGHAM DR
-----------------------------------------------------
City | WATCHUNG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07069-6133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-222-0688
-----------------------------------------------------
Fax | 908-222-0015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 NOTTINGHAM DR
-----------------------------------------------------
City | WATCHUNG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07069-6133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-222-0688
-----------------------------------------------------
Fax | 908-222-0015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 40QA00076600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------