Provider Demographics
NPI:1023094323
Name:GOTTFRIED, RICHARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GOTTFRIED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1296 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-2603
Mailing Address - Country:US
Mailing Address - Phone:914-235-8224
Mailing Address - Fax:914-235-6940
Practice Address - Street 1:1296 NORTH AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2603
Practice Address - Country:US
Practice Address - Phone:914-235-8224
Practice Address - Fax:914-235-6940
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01167064Medicaid
NY44F07OtherMEDICARE
NY110142529OtherRAILRAOD MEDICARE
NYE45058Medicare UPIN
NY110142529OtherRAILRAOD MEDICARE