Provider Demographics
NPI:1164855599
Name:GOTTLIEB, ADAM NEAL
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:NEAL
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 STONEHAVEN DR
Mailing Address - Street 2:#6
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6523
Mailing Address - Country:US
Mailing Address - Phone:561-502-3913
Mailing Address - Fax:
Practice Address - Street 1:1660 STONEHAVEN DR
Practice Address - Street 2:# 6
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-6523
Practice Address - Country:US
Practice Address - Phone:561-502-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPBCVH3561347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle