Provider Demographics
NPI:1154311900
Name:GOLDMAN DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:GOLDMAN DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-962-1115
Mailing Address - Street 1:150 BROADWAY
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4381
Mailing Address - Country:US
Mailing Address - Phone:212-962-1115
Mailing Address - Fax:212-962-1246
Practice Address - Street 1:150 BROADWAY
Practice Address - Street 2:SUITE 1110
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4381
Practice Address - Country:US
Practice Address - Phone:212-962-1115
Practice Address - Fax:212-962-1246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188106-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWCW741Medicare PIN