Provider Demographics
NPI:1447137484
Name:GOTTFRIED, EVAN (MS ED IN SPECIAL ED)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:GOTTFRIED
Suffix:
Gender:M
Credentials:MS ED IN SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WILLOW BROOK DR
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-2942
Mailing Address - Country:US
Mailing Address - Phone:201-282-1350
Mailing Address - Fax:
Practice Address - Street 1:1 WILLOW BROOK DR
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-2942
Practice Address - Country:US
Practice Address - Phone:201-282-1350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency