Provider Demographics
NPI:1770822736
Name:TOTTENVILLE PRIMARY OSTEOPATHIC MEDICINE PLLC
Entity Type:Organization
Organization Name:TOTTENVILLE PRIMARY OSTEOPATHIC MEDICINE PLLC
Other - Org Name:ADVANTAGE MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTTIGLIERI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-984-4094
Mailing Address - Street 1:PO BOX 70176
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-0176
Mailing Address - Country:US
Mailing Address - Phone:718-984-4094
Mailing Address - Fax:
Practice Address - Street 1:2955 VETERANS RD W
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2515
Practice Address - Country:US
Practice Address - Phone:718-984-4094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237430207Q00000X, 207QS0010X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty