Provider Demographics
NPI:1053512285
Name:GOLDMAN, MARK JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JASON
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:61 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8366
Mailing Address - Country:US
Mailing Address - Phone:631-659-1600
Mailing Address - Fax:631-665-5870
Practice Address - Street 1:61 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1089
Practice Address - Country:US
Practice Address - Phone:631-659-1800
Practice Address - Fax:631-382-4836
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2014-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY239823207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease