Provider Demographics
NPI:1710008438
Name:PETER M. GOTTESFELD, MD PC
Entity Type:Organization
Organization Name:PETER M. GOTTESFELD, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOTTESFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-241-7800
Mailing Address - Street 1:101 S BEDFORD RD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3439
Mailing Address - Country:US
Mailing Address - Phone:914-241-7800
Mailing Address - Fax:914-242-0224
Practice Address - Street 1:101 S BEDFORD RD
Practice Address - Street 2:SUITE 412
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3439
Practice Address - Country:US
Practice Address - Phone:914-241-7800
Practice Address - Fax:914-242-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO8590Medicare UPIN
NYWZT4X1Medicare PIN