Provider Demographics
NPI:1083766000
Name:GOLDWASER, ALBERTO MARIO (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:MARIO
Last Name:GOLDWASER
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 1:24 BERGEN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5482
Mailing Address - Country:US
Mailing Address - Phone:201-342-3500
Mailing Address - Fax:201-342-1900
Practice Address - Street 1:24 BERGEN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5482
Practice Address - Country:US
Practice Address - Phone:201-342-3500
Practice Address - Fax:201-342-1900
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142355-12084F0202X
NJ25MA053915002084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ597259Medicare ID - Type UnspecifiedOPTED-OUT