Provider Demographics
NPI:1669496469
Name:BOTTIGLIERI, THOMAS SAL (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SAL
Last Name:BOTTIGLIERI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:622 W 168TH ST PH 111130
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:212-305-9137
Mailing Address - Fax:212-304-7050
Practice Address - Street 1:500 GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4968
Practice Address - Country:US
Practice Address - Phone:201-569-4445
Practice Address - Fax:212-304-7050
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07982100207QS0010X
NY237430207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ153031Medicare UPIN