Provider Demographics
NPI:1417006396
Name:JAMES GOTT PT
Entity Type:Organization
Organization Name:JAMES GOTT PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-328-2288
Mailing Address - Street 1:2035 LAKEVILLE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-328-2288
Mailing Address - Fax:516-358-6946
Practice Address - Street 1:2035 LAKEVILLE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:516-328-2288
Practice Address - Fax:516-358-6946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q52802Medicare ID - Type Unspecified