Active NPI
David M Gottesman, MEDICAL DOCTOR
- Child & Adolescent Psychiatry Physician
- North Creek, NY
National Provider Identifier
1104155159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 099114
- Practice address
- 104 Fish Hollow Rd
North Creek, NY 12853-3502 - Phone
- (518) 494-5044
- Fax
- (518) 494-5044
- NPI assigned
- Dec 21, 2009
- 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 |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 099114 | NY | Primary |
Addresses
Primary practice location
104 Fish Hollow Rd
North Creek, NY 12853-3502
Mailing address
104 Fish Hollow Rd
North Creek, NY 12853-3502
Phone (518) 494-5044
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 099114 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1261353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1261353600000",
"number": "1104155159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 FISH HOLLOW RD",
"city": "NORTH CREEK",
"state": "NY",
"postal_code": "128533502",
"telephone_number": "518-494-5044",
"fax_number": "518-494-5044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 FISH HOLLOW RD",
"city": "NORTH CREEK",
"state": "NY",
"postal_code": "128533502",
"telephone_number": "518-494-5044",
"fax_number": "518-494-5044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOTTESMAN",
"first_name": "DAVID",
"middle_name": "M",
"credential": "MEDICAL DOCTOR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-12-21",
"last_updated": "2009-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "NY",
"license": "099114",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Creek, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.