Active NPI
Rebecca Gottlieb
- Endodontics
- Hewlett, NY
National Provider Identifier
1477844140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 057172
- Practice address
- 1705 Broadway
Suite 5
Hewlett, NY 11557-1600 - Phone
- (516) 593-0000
- NPI assigned
- Apr 28, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 057172 | NY | Primary |
Addresses
Primary practice location
1705 Broadway
Suite 5
Hewlett, NY 11557-1600
Mailing address
1705 Broadway
Suite 5
Hewlett, NY 11557-1600
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160307002455 | NY | Order and Referring Only - Dentist | 3779889423 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057172 | NY | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493683200000",
"number": "1477844140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1705 BROADWAY",
"address_2": "SUITE 5",
"city": "HEWLETT",
"state": "NY",
"postal_code": "115571600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1705 BROADWAY",
"address_2": "SUITE 5",
"city": "HEWLETT",
"state": "NY",
"postal_code": "115571600",
"telephone_number": "516-593-0000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOTTLIEB",
"first_name": "REBECCA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-04-28",
"last_updated": "2017-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NY",
"license": "057172",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hewlett, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2017; 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.