Provider Demographics
NPI:1912051236
Name:GITLIN, MICHAEL (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GITLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5711
Mailing Address - Country:US
Mailing Address - Phone:516-579-8950
Mailing Address - Fax:516-579-0092
Practice Address - Street 1:4250 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 4
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5711
Practice Address - Country:US
Practice Address - Phone:516-579-8950
Practice Address - Fax:516-579-0092
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041069122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01044408Medicaid