Provider Demographics
NPI:1134677487
Name:GOLDMAN, JAY (LAC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 EASTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-1023
Mailing Address - Country:US
Mailing Address - Phone:914-837-3135
Mailing Address - Fax:
Practice Address - Street 1:838 PELHAMDALE AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-1032
Practice Address - Country:US
Practice Address - Phone:914-837-3135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005758171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist