Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Michael S Gottlieb, FNP-BCANCCMSN

Individual provider Nurse Practitioner · NPI 1215462205

Michael S Gottlieb, FNP-BCANCCMSN is a Nurse Practitioner in Ronkonkoma, New York. Qualified in 2016, 10 years ago. Practices as a sole proprietor. Licensed in New York.

Years since qualifying
10
Licensed in
NY
In the registry since
2017

Practice location Address checks out

500 Peconic St 92A
Ronkonkoma, NY 11779-7100
Phone: (631) 833-0696
Fax: (206) 350-1094
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence F-341691 (NY)

Record details

NPI number1215462205
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP-BCANCCMSN
Sole proprietorYes
NPI enumeratedApril 27, 2017
Last updated in NPPESOctober 23, 2023
Certification dateOctober 23, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Ronkonkoma