Individual
MICHAEL S GOTTLIEB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
F.N.P-BC(ANCC) M.S.N
Contact information
Practice address
500 PECONIC ST, 92A, RONKONKOMA, NY 11779-7100
(631) 833-0696
(206) 350-1094
Mailing address
500 PECONIC ST, 92A, RONKONKOMA, NY 11779-7100
(929) 430-7907
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F-341691
NY
Other
Enumeration date
04/27/2017
Last updated
10/23/2023
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