Provider Demographics
NPI:1629294822
Name:GOTHAM PEDIATRICS, PC
Entity Type:Organization
Organization Name:GOTHAM PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FLAVIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:212-255-7733
Mailing Address - Street 1:59 W 12TH ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8563
Mailing Address - Country:US
Mailing Address - Phone:212-255-7733
Mailing Address - Fax:212-255-7855
Practice Address - Street 1:59 W 12TH ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8563
Practice Address - Country:US
Practice Address - Phone:212-255-7733
Practice Address - Fax:212-255-7855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty