| Gotham Medical Group Llp | |
|
314 W 14th St 5th Floor New York NY 10014-5002 | |
| (212) 620-0144 | |
| Not Available |
| Full Name | Gotham Medical Group Llp |
|---|---|
| Speciality | Internal Medicine |
| Location | 314 W 14th St, New York, New York |
| Authorized Official Name and Position | Stephen M. Dillon (OWNER) |
| Authorized Official Contact | 2126200144 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gotham Medical Group Llp 314 W 14th St 5th Floor New York NY 10014-5002 Ph: (212) 620-0144 | Gotham Medical Group Llp 314 W 14th St 5th Floor New York NY 10014-5002 Ph: (212) 620-0144 |
| NPI Number | 1124320056 |
|---|---|
| Provider Enumeration Date | 11/29/2010 |
| Last Update Date | 11/29/2010 |
| Medicare PECOS PAC ID | 2062694979 |
|---|---|
| Medicare Enrollment ID | O20110315000150 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124320056 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Krisczar J Bungay |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942277660 PECOS PAC ID: 5193616266 Enrollment ID: I20040320000504 |
| Provider Name | Stephen M Dillon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609855394 PECOS PAC ID: 1052369246 Enrollment ID: I20050104000917 |
| Provider Name | Samantha Fleischman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699053108 PECOS PAC ID: 3274896980 Enrollment ID: I20180411001072 |
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