Provider Demographics
NPI:1093975781
Name:GOTTESFELD, DAVID STUART
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STUART
Last Name:GOTTESFELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:GOTTESFELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:117 WEST 72ND STREET SUITE 5 EAST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3204
Mailing Address - Country:US
Mailing Address - Phone:800-638-3939
Mailing Address - Fax:
Practice Address - Street 1:117 W 72ND ST STE 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3204
Practice Address - Country:US
Practice Address - Phone:800-638-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011483103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist