Provider Demographics
NPI:1518597046
Name:GOTTESMAN, SARA JO-ANN
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JO-ANN
Last Name:GOTTESMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WOODHAIL ST
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-5115
Mailing Address - Country:US
Mailing Address - Phone:516-902-4388
Mailing Address - Fax:
Practice Address - Street 1:75 WOODHAIL ST
Practice Address - Street 2:
Practice Address - City:LIDO BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-5115
Practice Address - Country:US
Practice Address - Phone:516-902-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency