Provider Demographics
NPI:1124291687
Name:GOTHAM NEUROSURGERY, PLLC
Entity type:Organization
Organization Name:GOTHAM NEUROSURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDERS
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO,
Authorized Official - Phone:718-250-8103
Mailing Address - Street 1:240 WILLOUGHBY ST
Mailing Address - Street 2:SUITE 4E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5465
Mailing Address - Country:US
Mailing Address - Phone:718-250-8103
Mailing Address - Fax:718-250-6977
Practice Address - Street 1:240 WILLOUGHBY ST
Practice Address - Street 2:SUITE 4E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5465
Practice Address - Country:US
Practice Address - Phone:718-250-8103
Practice Address - Fax:718-250-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217215207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02659387Medicaid