Provider Demographics
NPI:1801632245
Name:GOTTLIEB, FAIGA FAYE (MA)
Entity type:Individual
Prefix:
First Name:FAIGA
Middle Name:FAYE
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:FAIGY
Other - Middle Name:FAYE
Other - Last Name:GOTTLIEB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13825 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2819
Mailing Address - Country:US
Mailing Address - Phone:954-415-1949
Mailing Address - Fax:
Practice Address - Street 1:13825 76TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2819
Practice Address - Country:US
Practice Address - Phone:954-415-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1191622174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist