Provider Demographics
NPI:1144244104
Name:GOTTLIEB, JOSEPH PAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PAUL
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 PONTIAC PL
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1231
Mailing Address - Country:US
Mailing Address - Phone:516-735-0846
Mailing Address - Fax:
Practice Address - Street 1:1311 BROADWAY
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-2115
Practice Address - Country:US
Practice Address - Phone:516-374-2934
Practice Address - Fax:516-374-2915
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist