Provider Demographics
NPI:1467741447
Name:PAUL R. GOLDMAN, P.T., P.C.
Entity Type:Organization
Organization Name:PAUL R. GOLDMAN, P.T., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-566-1398
Mailing Address - Street 1:19 MANSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-4033
Mailing Address - Country:US
Mailing Address - Phone:516-566-1398
Mailing Address - Fax:516-799-4542
Practice Address - Street 1:19 MANSFIELD DR
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-4033
Practice Address - Country:US
Practice Address - Phone:516-566-1398
Practice Address - Fax:516-799-4542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010820251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ82511Medicare UPIN