Basic Information
| Provider Information | |||||||||
| NPI: | 1770539660 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOTTESMAN | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 158 W 27TH ST | ||||||||
| Address2: | 11TH FL S | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100016216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125632497 | ||||||||
| FaxNumber: | 2125630605 | ||||||||
| Practice Location | |||||||||
| Address1: | DAVIS AVENUE AT EAST POST ROAD | ||||||||
| Address2: | WHITE PLAINS HOSPITALIST DEPT | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106014615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146812560 | ||||||||
| FaxNumber: | 9146812590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 06/24/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 203808 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1842535 | 01 | NY | UNITED HEALTHCARE | OTHER | 5360615 | 01 | NY | AETNA - PPO | OTHER | P3659664 | 01 | NY | OXFORD HEALTH PLANS | OTHER | 3144344 | 01 | NY | AETNA - HMO | OTHER | 4C8265 | 01 | NY | HEALTH NET | OTHER | 8243508 | 01 | NY | CIGNA | OTHER | 7B3241 | 01 | NY | EMPIRE BC/BS | OTHER |