Provider Demographics
NPI:1275657413
Name:GOTFRIED, EDWARD A (DO)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:GOTFRIED
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:NORTHERN BLVD
Mailing Address - Street 2:ACADEMIC HEALTH CARE CENTER NY INSTITUTE OF TECHNOLOGY
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-8000
Mailing Address - Country:US
Mailing Address - Phone:516-686-1300
Mailing Address - Fax:516-686-7890
Practice Address - Street 1:NORTHERN BLVD
Practice Address - Street 2:ACADEMIC HEALTH CARE CENTER NY INSTITUTE OF TECHNOLOGY
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-8000
Practice Address - Country:US
Practice Address - Phone:516-686-1300
Practice Address - Fax:516-686-7890
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2008-06-30
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Provider Licenses
StateLicense IDTaxonomies
NY240165208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1275657413OtherNPI NUMBER
NY1821048612OtherGROUP NPI NUMBER
D66280Medicare UPIN