Provider Demographics
NPI:1073600367
Name:GOLOMB, FREDERICK MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:MARTIN
Last Name:GOLOMB
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 1:80 CENTRAL PARK W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5204
Mailing Address - Country:US
Mailing Address - Phone:201-567-3680
Mailing Address - Fax:
Practice Address - Street 1:80 CENTRAL PARK W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5204
Practice Address - Country:US
Practice Address - Phone:201-567-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70889174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110091Medicare ID - Type Unspecified
NYBOO-27Medicare UPIN