Provider Demographics
NPI:1821268830
Name:STANLEY GOTTLIEB MD
Entity Type:Organization
Organization Name:STANLEY GOTTLIEB MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-238-0035
Mailing Address - Street 1:575 CRANBURY RD
Mailing Address - Street 2:B3A
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5404
Mailing Address - Country:US
Mailing Address - Phone:732-238-0035
Mailing Address - Fax:732-238-0199
Practice Address - Street 1:575 CRANBURY RD
Practice Address - Street 2:B3A
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5404
Practice Address - Country:US
Practice Address - Phone:732-238-0035
Practice Address - Fax:732-238-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA029072002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
448913Medicare PIN
C54919Medicare UPIN