Provider Demographics
NPI:1124026315
Name:GOLDRING, SAMUEL NATHAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:NATHAN
Last Name:GOLDRING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 E 87TH ST
Mailing Address - Street 2:STE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2700
Mailing Address - Country:US
Mailing Address - Phone:212-360-6460
Mailing Address - Fax:212-360-6460
Practice Address - Street 1:153 E 87TH ST
Practice Address - Street 2:STE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2700
Practice Address - Country:US
Practice Address - Phone:212-360-6460
Practice Address - Fax:212-360-6460
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003014-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00516096Medicaid
NY00516096Medicaid
NYP32651Medicare ID - Type Unspecified