Provider Demographics
NPI:1174529705
Name:GOTTLIEB, JOEL MARTIN I (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:MARTIN
Last Name:GOTTLIEB
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66SUNSET STRIP
Mailing Address - Street 2:STE107
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1362
Mailing Address - Country:US
Mailing Address - Phone:973-584-4451
Mailing Address - Fax:973-584-2099
Practice Address - Street 1:66SUNSET STRIP
Practice Address - Street 2:STE107
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1362
Practice Address - Country:US
Practice Address - Phone:973-584-4451
Practice Address - Fax:973-584-2099
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04231000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4705106Medicaid
NJOK5391OtherHEALTHNET
NJ180035676OtherRAILROAD MEDICARE
NJ1027823OtherAETNA
NJIS478OtherOXFORD
NJOK5391OtherHEALTHNET
NJE53421Medicare UPIN