Provider Demographics
NPI:1043285331
Name:GUTTERMAN, HEATH (DPM)
Entity Type:Individual
Prefix:DR
First Name:HEATH
Middle Name:
Last Name:GUTTERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 ELMWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3226
Mailing Address - Country:US
Mailing Address - Phone:516-785-7156
Mailing Address - Fax:516-465-0328
Practice Address - Street 1:467 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2719
Practice Address - Country:US
Practice Address - Phone:516-489-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005957213E00000X
NJ25MD00280900213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0043559Medicaid
NY02560589Medicaid
NYP00189597Medicare PIN
NJ0043559Medicaid
NYU99850Medicare UPIN
NY02560589Medicaid