Provider Demographics
NPI:1295095883
Name:GARTENBERG FAMILY MEDICINE, PLLC
Entity type:Organization
Organization Name:GARTENBERG FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GARTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-363-1631
Mailing Address - Street 1:16211 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE A6A-213
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1584
Mailing Address - Country:US
Mailing Address - Phone:602-363-1631
Mailing Address - Fax:888-360-8644
Practice Address - Street 1:8575 E PRINCESS DR
Practice Address - Street 2:SUITE # 107
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5483
Practice Address - Country:US
Practice Address - Phone:602-363-1631
Practice Address - Fax:888-360-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ154006OtherMEDICARE PTAN