Provider Demographics
NPI:1114011368
Name:GOTTESFELD, PETER M (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:GOTTESFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:334 UNDERHILL AVE
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4530
Mailing Address - Country:US
Mailing Address - Phone:914-241-7800
Mailing Address - Fax:914-242-0224
Practice Address - Street 1:101 S BEDFORD RD
Practice Address - Street 2:SUITE 412
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3439
Practice Address - Country:US
Practice Address - Phone:914-241-7800
Practice Address - Fax:914-242-0224
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2017-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY175170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08590Medicare UPIN
NYPG033E7310Medicare PIN