Provider Demographics
NPI:1023565991
Name:ROBERT STEVEN GOTLIN DO, PLLC
Entity type:Organization
Organization Name:ROBERT STEVEN GOTLIN DO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-247-8017
Mailing Address - Street 1:119 W 57TH ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2303
Mailing Address - Country:US
Mailing Address - Phone:212-247-8017
Mailing Address - Fax:212-421-1750
Practice Address - Street 1:119 W 57TH ST
Practice Address - Street 2:SUITE 212
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2303
Practice Address - Country:US
Practice Address - Phone:212-247-8017
Practice Address - Fax:212-421-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176382261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE81671Medicare UPIN