Provider Demographics
NPI:1497997811
Name:GOTTLIEB, YAEL DEBORAH (MD)
Entity Type:Individual
Prefix:MRS
First Name:YAEL
Middle Name:DEBORAH
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WESTVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5602
Mailing Address - Country:US
Mailing Address - Phone:973-228-6866
Mailing Address - Fax:973-228-4133
Practice Address - Street 1:30 WESTVILLE AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5602
Practice Address - Country:US
Practice Address - Phone:973-228-6866
Practice Address - Fax:973-228-4133
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP20080-0363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant