Provider Demographics
NPI:1598865081
Name:GOTLIEB, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GOTLIEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:CARE MOUNT MEDICAL PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:342 ROUTE 202
Practice Address - Street 2:CARE MOUNT MEDICAL PC
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-3207
Practice Address - Country:US
Practice Address - Phone:914-277-4448
Practice Address - Fax:914-242-1516
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2024-03-09
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Provider Licenses
StateLicense IDTaxonomies
NY227350207R00000X
FL165696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02412297Medicaid
NY72S5120661Medicare PIN
NYH84275Medicare UPIN