Provider Demographics
NPI:1508198110
Name:GOLDFELD, DMITRY (RPH)
Entity Type:Individual
Prefix:
First Name:DMITRY
Middle Name:
Last Name:GOLDFELD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11602 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2073
Mailing Address - Country:US
Mailing Address - Phone:718-945-7781
Mailing Address - Fax:718-945-7785
Practice Address - Street 1:11602 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2073
Practice Address - Country:US
Practice Address - Phone:718-945-7781
Practice Address - Fax:718-945-7785
Is Sole Proprietor?:No
Enumeration Date:2010-02-06
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY47368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist