Provider Demographics
NPI:1114188844
Name:GOTTESMAN, SIMM (AP)
Entity Type:Individual
Prefix:
First Name:SIMM
Middle Name:
Last Name:GOTTESMAN
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8904-F SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7377
Mailing Address - Country:US
Mailing Address - Phone:561-488-4887
Mailing Address - Fax:561-488-4889
Practice Address - Street 1:8904-F SW 22ND ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7377
Practice Address - Country:US
Practice Address - Phone:561-488-4887
Practice Address - Fax:561-488-4889
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000036171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist