Provider Demographics
NPI:1073513735
Name:GOLDMARK, GEORGE M (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:GOLDMARK
Suffix:
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 1:350 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3002
Mailing Address - Country:US
Mailing Address - Phone:845-634-7500
Mailing Address - Fax:845-634-7566
Practice Address - Street 1:350 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3002
Practice Address - Country:US
Practice Address - Phone:845-634-7500
Practice Address - Fax:845-634-7566
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120730207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00549413Medicaid
NYOD0445OtherHEALTHNET
NYRS169OtherOXFORD
NY0062304OtherGAI
B13420Medicare UPIN
NY00549413Medicaid