Provider Demographics
NPI:1548313745
Name:GOTTESMAN, SAMUEL M (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:M
Last Name:GOTTESMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 BROAD STREET PLZ
Mailing Address - Street 2:ADIRONDACK MEDICAL SERVICES
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4363
Mailing Address - Country:US
Mailing Address - Phone:518-926-6992
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:102 PARK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4403
Practice Address - Country:US
Practice Address - Phone:518-798-1719
Practice Address - Fax:518-798-1943
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2015-08-18
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Provider Licenses
StateLicense IDTaxonomies
NY110911-1208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00368621Medicaid
NYJ400223707Medicare PIN
GA441343205Medicare PIN
B80603Medicare UPIN