Provider Demographics
NPI:1104155159
Name:GOTTESMAN, DAVID M (MEDICAL DOCTOR)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:GOTTESMAN
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 FISH HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:12853-3502
Mailing Address - Country:US
Mailing Address - Phone:518-494-5044
Mailing Address - Fax:518-494-5044
Practice Address - Street 1:104 FISH HOLLOW RD
Practice Address - Street 2:
Practice Address - City:NORTH CREEK
Practice Address - State:NY
Practice Address - Zip Code:12853-3502
Practice Address - Country:US
Practice Address - Phone:518-494-5044
Practice Address - Fax:518-494-5044
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0991142084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry