Provider Demographics
NPI:1104822212
Name:GOLDMAN, STEPHEN ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3014
Mailing Address - Country:US
Mailing Address - Phone:516-433-0147
Mailing Address - Fax:516-942-7258
Practice Address - Street 1:309 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3014
Practice Address - Country:US
Practice Address - Phone:516-433-0147
Practice Address - Fax:516-942-7258
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6473130001Medicare NSC