Provider Demographics
NPI:1285843953
Name:GOLDMAN, STEVEN KYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:KYLE
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 1:224 TAYLOR MILLS RD
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3281
Mailing Address - Country:US
Mailing Address - Phone:732-577-9600
Mailing Address - Fax:732-577-0062
Practice Address - Street 1:224 TAYLOR MILLS RD
Practice Address - Street 2:SUITE 105A
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3281
Practice Address - Country:US
Practice Address - Phone:732-577-9600
Practice Address - Fax:732-577-0062
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00496600111N00000X
NYX008199111N00000X
PADC 006685 L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU63967Medicare UPIN
NJG0591087Medicare ID - Type Unspecified