Active NPI
Stephen Alan Gootblatt, MD
- Internal Medicine Physician
- Lakewood, NJ
National Provider Identifier
1053587212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 25MA08071600
- Practice address
- 171 A Boxwood Drive
Lakewood, NJ 08701 - Phone
- (732) 367-6079
- Fax
- (732) 367-6079
- NPI assigned
- May 7, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 25MA08071600 | NJ | Primary |
Addresses
Primary practice location
171 A Boxwood Drive
Lakewood, NJ 08701
Mailing address
171 A Boxwood Drive
Lakewood, NJ 08701
Phone (732) 367-6079
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA08071600 | NJ | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210118400000",
"number": "1053587212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "171 A BOXWOOD DRIVE",
"city": "LAKEWOOD",
"state": "NJ",
"postal_code": "08701",
"telephone_number": "732-367-6079",
"fax_number": "732-367-6079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "171 A BOXWOOD DRIVE",
"city": "LAKEWOOD",
"state": "NJ",
"postal_code": "08701",
"telephone_number": "732-367-6079",
"fax_number": "732-367-6079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOOTBLATT",
"first_name": "STEPHEN",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-07",
"last_updated": "2008-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NJ",
"license": "25MA08071600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.