Provider Demographics
NPI:1144396110
Name:PAUL N GOTKIN & DAVID A GUBERNICK DPM PA
Entity Type:Organization
Organization Name:PAUL N GOTKIN & DAVID A GUBERNICK DPM PA
Other - Org Name:TREASURE COAST PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:N
Authorized Official - Last Name:GOTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-286-9912
Mailing Address - Street 1:2291 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4530
Mailing Address - Country:US
Mailing Address - Phone:772-286-9912
Mailing Address - Fax:772-286-2405
Practice Address - Street 1:1095 NW SAINT LUCIE WEST BLVD # 222
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1719
Practice Address - Country:US
Practice Address - Phone:772-785-5580
Practice Address - Fax:772-785-5528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029741100Medicaid
FLU16651Medicare UPIN
FL029741100Medicaid