MEDICARE: DR. JOSEPH EDWARD GOTTESMAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	017525	NY

General Provider Information

NPI Number	:	1588280473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH EDWARD GOTTESMAN PH.D.

Provider Business Mailing Address
First Line	:	6 TARA LN
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-7133
Country	:	US
Telephone Number	:	516-642-9374
Fax Number	:	631-940-7691

Provider Business Practice Location Address
First Line	:	6 TARA LN
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-7133
Country	:	US
Telephone Number	:	516-642-9374
Fax Number	:	631-940-7691

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	06/17/2020

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