Active NPI
Samuel M Gottesman, MD
- Urology Physician
- Glens Falls, NY
National Provider Identifier
1548313745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 110911-1
- Practice address
- 102 Park St
Suite 201
Glens Falls, NY 12801-4403 - Phone
- (518) 798-1719
- Fax
- (518) 798-1943
- NPI assigned
- Jan 19, 2007
- Last updated
- Aug 18, 2015
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Urology Physician | 208800000X | 110911-1 | NY | Primary |
Addresses
Primary practice location
102 Park St
Suite 201
Glens Falls, NY 12801-4403
Mailing address
2 Broad Street PLZ
Adirondack Medical Services
Glens Falls, NY 12801-4363
Phone (518) 926-6992
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00368621 | Medicaid | NY |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110911-1 | NY | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439856000000",
"number": "1548313745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 BROAD STREET PLZ",
"address_2": "ADIRONDACK MEDICAL SERVICES",
"city": "GLENS FALLS",
"state": "NY",
"postal_code": "128014363",
"telephone_number": "518-926-6992",
"fax_number": "518-926-6983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 PARK ST",
"address_2": "SUITE 201",
"city": "GLENS FALLS",
"state": "NY",
"postal_code": "128014403",
"telephone_number": "518-798-1719",
"fax_number": "518-798-1943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOTTESMAN",
"first_name": "SAMUEL",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-19",
"last_updated": "2015-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "NY",
"license": "110911-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00368621",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glens Falls, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.