Provider Demographics
NPI:1376570523
Name:GOLDFARB, CHARLES RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RICHARD
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 1:1 GUSTAVE L. LEVY PLACE
Mailing Address - Street 2:BOX 1194
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:212-241-8395
Mailing Address - Fax:212-289-0092
Practice Address - Street 1:144 4TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4901
Practice Address - Country:US
Practice Address - Phone:212-473-2300
Practice Address - Fax:212-473-4780
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1093832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB01364Medicare UPIN
NY12A481Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID#
NY00761748Medicaid