Provider Demographics
NPI:1841368693
Name:GOTTLIEB, HOWARD PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:PAUL
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6161
Mailing Address - Country:US
Mailing Address - Phone:845-519-5610
Mailing Address - Fax:
Practice Address - Street 1:185 FAIR ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-0502
Practice Address - Country:US
Practice Address - Phone:845-883-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124704-12084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00276444Medicaid
NY124704-1OtherNY STATE PHYSICIAN LICENS
NY124704-1OtherNY STATE PHYSICIAN LICENS
NYE83952Medicare UPIN
NY124704-1OtherNY STATE PHYSICIAN LICENS