Basic Information
Provider Information
NPI: 1003002072
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOTESMAN
FirstName: ALEXANDER
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1586 E 14TH ST
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112307134
CountryCode: US
TelephoneNumber: 3475648694
FaxNumber:  
Practice Location
Address1: 1374 WHITEHORSE HAMILTON SQUARE RD
Address2:  
City: HAMILTON
State: NJ
PostalCode: 086903701
CountryCode: US
TelephoneNumber: 6095861319
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/24/2007
LastUpdateDate: 09/12/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208800000X25MA09130400NJY Allopathic & Osteopathic PhysiciansUrology 
208800000X221653NYN Allopathic & Osteopathic PhysiciansUrology 

No ID Information.


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