Provider Demographics
NPI:1265493456
Name:GOTTESMAN, ARON TZVI (OD)
Entity Type:Individual
Prefix:DR
First Name:ARON
Middle Name:TZVI
Last Name:GOTTESMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 ROUTE 306
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1209
Mailing Address - Country:US
Mailing Address - Phone:845-362-2020
Mailing Address - Fax:845-352-2073
Practice Address - Street 1:455 ROUTE 306
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1209
Practice Address - Country:US
Practice Address - Phone:845-362-2020
Practice Address - Fax:845-362-2073
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006537152W00000X
NJOAXXXXXXX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P3083414OtherOXFORD
NYA100107089Medicare PIN
NYC258E1Medicare PIN
NJ063107Medicare PIN
P3083414OtherOXFORD
NYC31671Medicare PIN