Provider Demographics
NPI:1518025840
Name:GUTTERMAN, VALERIE ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ELLEN
Last Name:GUTTERMAN
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 1:420 LEXINGTON AVE
Mailing Address - Street 2:SUITE 1644
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10170-0002
Mailing Address - Country:US
Mailing Address - Phone:212-861-3313
Mailing Address - Fax:212-987-2394
Practice Address - Street 1:420 LEXINGTON AVE
Practice Address - Street 2:SUITE 1644
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10170-0002
Practice Address - Country:US
Practice Address - Phone:212-861-3313
Practice Address - Fax:212-987-2394
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179665207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01500930Medicaid
NY01500930Medicaid