Individual
JENNA GOTTLIEB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1901 1ST AVE, NEW YORK, NY 10029-7491
(631) 275-9695
Mailing address
1901 1ST AVE, NEW YORK, NY 10029-7494
(212) 423-6416
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
024214
NY
Other
Enumeration date
10/03/2019
Last updated
01/17/2021
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