Provider Demographics
NPI:1326036823
Name:GOLDFARB, DAVID ALAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:GOLDFARB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3723
Mailing Address - Country:US
Mailing Address - Phone:845-561-4274
Mailing Address - Fax:845-561-6665
Practice Address - Street 1:313 FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3723
Practice Address - Country:US
Practice Address - Phone:845-561-4274
Practice Address - Fax:845-561-6665
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124684I207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00534749Medicaid
29A381Medicare ID - Type Unspecified
C07863Medicare UPIN