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General NPI Number Information
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NPI Number | 1750556312
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Entity Type | Organization
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Legal Business Name | SAMUEL GOTTESMAN MD PC
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 90 SOUTH ST STE J
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City | GLENS FALLS
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State | NY
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Zip | 12801-4328
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Country | US
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Telephone | 518-793-5142
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Fax |
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Provider Business Mailing Address
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Address Line | 90 SOUTH ST STE J
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City | GLENS FALLS
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State | NY
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Zip | 12801-4328
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Country | US
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Telephone | 518-793-5142
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | SAMUEL GOTTESMAN
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Credential | MD
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Telephone | 518-793-5142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 110911-1
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License Number State | NY
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