Provider Demographics
NPI:1740494301
Name:GOTTESMANN, NAN C (PT)
Entity type:Individual
Prefix:
First Name:NAN
Middle Name:C
Last Name:GOTTESMANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6133
Mailing Address - Country:US
Mailing Address - Phone:908-222-0688
Mailing Address - Fax:908-222-0015
Practice Address - Street 1:25 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6133
Practice Address - Country:US
Practice Address - Phone:908-222-0688
Practice Address - Fax:908-222-0015
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00076600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist