OrganizationGotham Psychiatric PcPsychiatry & NeurologyAllopathic & Osteopathic PhysiciansPractice Address5419 Hollywood Blvd Ste C172, Los Angeles, CA 90027-3480(213) 814-0040PECOS EnrollmentBased on the most recent information from CMS, provider Gotham Psychiatric Pc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 34 days ago.Profile DetailsProvider ID1306399951Provider TypeOrganizationFull NameGotham Psychiatric PcSubpartNoEnumeration Date8/1/2016Last Updated12/8/2020Contact InformationPractice LocationPractice Address5419 Hollywood Blvd Ste C172, Los Angeles, CA 90027-3480Phone(213) 814-0040Fax(917) 338-1381Mailing LocationMailing Address600 N Brand Blvd Ste 640, Glendale, CA 91203-4215Phone(213) 814-0040Fax(917) 338-1381Authorized OfficialNameGolder, Michael (President)Phone(213) 814-0040Provider TaxonomiesCodeDescriptionLicenseCode2084P0800XPrimaryDescriptionPsychiatry & NeurologyAllopathic & Osteopathic PhysiciansLicenseG141046California