Provider Demographics
NPI:1245594514
Name:GOTTLIEB, BROCHA GELLA (MS)
Entity Type:Individual
Prefix:
First Name:BROCHA
Middle Name:GELLA
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1320
Mailing Address - Country:US
Mailing Address - Phone:917-324-0180
Mailing Address - Fax:917-324-0180
Practice Address - Street 1:4901 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1320
Practice Address - Country:US
Practice Address - Phone:917-324-0180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist