Provider Demographics
NPI:1083919997
Name:GOTTLIEB, MARTIN (DDS)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:GOTTLIEB
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 1:19 MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-2240
Mailing Address - Country:US
Mailing Address - Phone:212-941-9095
Mailing Address - Fax:212-274-9172
Practice Address - Street 1:19 MURRAY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-2240
Practice Address - Country:US
Practice Address - Phone:212-941-9095
Practice Address - Fax:212-274-9172
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0305091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice