Provider Demographics
NPI:1417021593
Name:GOLDWASSER, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:GOLDWASSER
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 1:156 LAKESIDE DR S
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1721
Mailing Address - Country:US
Mailing Address - Phone:516-234-9120
Mailing Address - Fax:516-612-3565
Practice Address - Street 1:156 LAKESIDE DR S
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1721
Practice Address - Country:US
Practice Address - Phone:516-234-9120
Practice Address - Fax:516-612-3565
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157084-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0060904OtherGHI
38612OtherCIGNA
4061056OtherAETNA
7517OtherVYTRA
AP052OtherOXFORD
AC48934OtherMDNY
NY00828780Medicaid
AP052OtherOXFORD
4061056OtherAETNA