Provider Demographics
NPI:1952399610
Name:GUTTENPLAN, NILS A (MD)
Entity Type:Individual
Prefix:DR
First Name:NILS
Middle Name:A
Last Name:GUTTENPLAN
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 1:1421 3RD AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1802
Mailing Address - Country:US
Mailing Address - Phone:212-249-6500
Mailing Address - Fax:212-249-2906
Practice Address - Street 1:1421 3RD AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1802
Practice Address - Country:US
Practice Address - Phone:212-249-6500
Practice Address - Fax:212-249-2906
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245033174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300000765Medicare PIN