Provider Demographics
NPI:1437336039
Name:GOTTLIEB, RICKI L (MD)
Entity Type:Individual
Prefix:
First Name:RICKI
Middle Name:L
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:765 RT 10 EAST SUITE 203
Mailing Address - Street 2:COLLEGE PLAZA PEDIATRICS
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-1925
Mailing Address - Country:US
Mailing Address - Phone:973-659-9991
Mailing Address - Fax:973-659-9991
Practice Address - Street 1:765 ROUTE 10 EAST, SUITE 203
Practice Address - Street 2:COLLEGE PLAZA PEDIATRICS
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-1925
Practice Address - Country:US
Practice Address - Phone:973-659-9991
Practice Address - Fax:973-659-9632
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05950700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics