Jenna Gottlieb, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

024214 Issued in NY

Practice address

1901 1St Ave
New York, NY 10029-7491

Phone

(631) 275-9695

NPI assigned

Oct 3, 2019

Sex

Female

Sole proprietor

No

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 NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

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

Interoperability endpoints

• FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2
• FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/
• Direct secure messaging: jgottlieb847728@nychhc.direct-ci.com

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.

• New York Society for the Relief of Ruptured & Crippled Maintaining

  • Special Hospital
  • New York, NY
  • NPI 1427496652
  Medicare reassignment
• New York Society for the Relief of Ruptured & Crippled Maintaining

  • Specialist
  • Paramus, NJ
  • NPI 1417357849
  NPD
• New York Society for the Relief of Ruptured & Crippled Maintaining

  • General Acute Care Hospital
  • New York, NY
  • NPI 1598703019
  NPD (past)

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

{
    "created_epoch": "1570060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610841600000",
    "number": "1902447766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 1ST AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100297494",
            "telephone_number": "212-423-6416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 1ST AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100297491",
            "telephone_number": "631-275-9695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTTLIEB",
        "first_name": "JENNA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-03",
        "last_updated": "2021-01-17",
        "certification_date": "2021-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "024214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dana Michelle Gottlieb
• David Gottlieb, PSY.D.
• Erica Rudd Gottlieb, PHD
• Geoffrey J Gottlieb, MD
• Jacob J Gottlieb, MD
• Joanne Gottlieb
• Joyce Gottlieb, ED.D., L.C.S.W.
• Justine Gottlieb, LCSWR
• Mandy Melanie Gottlieb
• Martin Gottlieb, D.D.S

• Surgical Physician Assistant in New York, NY
• Providers in New York, NY by specialty
• Surgical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2021; 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.

Verify at the official NPI Registry.