Individual provider Active NPI

Marc David Gottlieb, M.D.

  • Otolaryngology Physician
  • Brooklyn, NY
National Provider Identifier
1104803287
Registry record updated Apr 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
196622 Issued in NY
Practice address
6740 4TH Ave FL 3
Brooklyn, NY 11220-5350
Phone
(929) 455-2700
NPI assigned
Dec 29, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 196622 NY Primary

Addresses

Primary practice location

6740 4TH Ave FL 3
Brooklyn, NY 11220-5350

Mailing address

121 Dekalb Ave
Ste 9E Maynard BLDG
Brooklyn, NY 11201-5425
Phone (718) 250-8520

Other practice location 1

121 Dekalb Ave
Ste 9E Maynard BLDG
Brooklyn, NY 11201-5425
Phone (718) 250-8520

Other identifiers 1

IdentifierTypeStateIssuer
01888499MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mgottlieb273299@nyumc.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050207000598 NY Practitioner - Otolaryngology 6002867132 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

13303 Jamaica Ave
Jamaica, NY 11418-2618
Phone (718) 206-6923

150 55TH St
Brooklyn, NY 11220-2508
Phone (718) 630-7000

530 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

550 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

560 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

9777 Queens Blvd
Rego Park, NY 11374-3335
Phone (718) 261-9100

Hospital & facility affiliations

  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
196622NYMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
NYU Langone Hospitals CurrentSince Nov 1, 2018 Accepting new patients
Jamaica Hospital CurrentSince Apr 1, 2011 Accepting new patients
New York University CurrentSince Nov 1, 2018 Accepting new patients
TJH Medical Services, P.C. Otolaryngology CurrentSince Dec 2, 2010 Accepting new patients
New York University Otolaryngology CurrentSince Nov 1, 2018 Accepting new patients
NYU Langone Hospitals CurrentSince Nov 1, 2018 Accepting new patients
NYU Langone Hospitals Current Accepting new patients
Jamaica Hospital CurrentSince Apr 1, 2011 Accepting new patients
NYU Langone Hospitals Past Accepting new patients
L&L Cervantes Medical PC PastSince Mar 15, 2009 Accepting new patients

Locations

121 DeKalb Ave
Ste 9E
Brooklyn, NY 11201
Phone (718) 250-8520

6740 4th Ave
Fl 3
Brooklyn, NY 11220
Phone (929) 455-2000

121 DeKalb Ave
#9E
Brooklyn, NY 11201
Phone (718) 250-8520

150 55th St
Brooklyn, NY 11220
Phone (718) 630-7185

121 DeKalb Ave
Brooklyn, NY 11201
Phone (718) 250-6604

11940 Metropolitan Ave
Kew Gardens, NY 11415
Phone (718) 849-0839

301 E 17th St
New York, NY 10003
Phone (212) 460-0125

9777 Queens Blvd
Rego Park, NY 11374
Phone (718) 275-9300

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

8900 Van Wyck Expy
Richmond Hill, NY 11418
Phone (718) 206-6088

70 E Sunrise Hwy
Valley Stream, NY 11581
Phone (516) 825-3600

70 E Sunrise Hwy
Fl 5
Valley Stream, NY 11581
Phone (516) 825-3600

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: mgottlieb676173@nychhc.direct-ci.com

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1104803287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 DEKALB AVE",
            "address_2": "STE 9E MAYNARD BLDG",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112015425",
            "telephone_number": "718-250-8520",
            "fax_number": "718-250-6327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6740 4TH AVE FL 3",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112205350",
            "telephone_number": "929-455-2700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 Dekalb Ave",
            "address_2": "STE 9E MAYNARD BLDG",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112015425",
            "country_code": "US",
            "telephone_number": "718-250-8520",
            "fax_number": "718-250-6327",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOTTLIEB",
        "first_name": "MARC",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "196622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01888499",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgottlieb273299@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "6740 4th Ave Fl 3",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "112205350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.