Michael S Gottlieb, F.N.P-BC(ANCC) M.S.N

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

F-341691 Issued in NY

Practice address

500 Peconic St
92A
Ronkonkoma, NY 11779-7100

Phone

(631) 833-0696

Fax

(206) 350-1094

NPI assigned

Apr 27, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

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

• Community Care Health Network LLC

  dba Matrix Medical Network

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  FL

  Medicare reassignment NPD

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

{
    "created_epoch": "1493251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1215462205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 PECONIC ST",
            "address_2": "92A",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117797100",
            "telephone_number": "929-430-7907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 PECONIC ST",
            "address_2": "92A",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117797100",
            "telephone_number": "631-833-0696",
            "fax_number": "206-350-1094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTTLIEB",
        "first_name": "MICHAEL",
        "middle_name": "S",
        "credential": "F.N.P-BC(ANCC) M.S.N",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-27",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "F-341691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Gomes, LMT
• Yaritza Gomez-Nacht, LMHC, CRC, MS.ED, MA
• Jessica Gonzalez
• Shanna Beth Gonzalez, LMSW
• Rachelle Gooden
• Marissa Elizabeth Gouskos, MS ED
• Sonia Gracia, PA-C
• Kaitlin Graff
• Alyssa Mary Graziano
• Debra Ann Grimes, LMT

• Nurse Practitioner in Ronkonkoma, NY
• Providers in Ronkonkoma, NY by specialty
• Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.