Provider Demographics
NPI:1972652832
Name:GOTTFRIED, MAUREEN (DO)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:GOTTFRIED
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HARBOR LANE
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2470
Mailing Address - Country:US
Mailing Address - Phone:609-653-9110
Mailing Address - Fax:609-653-4105
Practice Address - Street 1:110 HARBOR LANE
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2470
Practice Address - Country:US
Practice Address - Phone:609-653-9110
Practice Address - Fax:609-653-4105
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB060994002084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G47371Medicare UPIN
NJ0000900887Medicare PIN