Provider Demographics
NPI:1114330255
Name:GOTHAM MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:GOTHAM MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-524-1665
Mailing Address - Street 1:1801 SKYWAY DR
Mailing Address - Street 2:ATTN: BARBARA LEWIS
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-2714
Mailing Address - Country:US
Mailing Address - Phone:212-874-3384
Mailing Address - Fax:646-873-6600
Practice Address - Street 1:535 5TH AVE
Practice Address - Street 2:SUITE 611
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3620
Practice Address - Country:US
Practice Address - Phone:646-524-1665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty