Provider Demographics
NPI:1568473726
Name:GOLDMAN, GERSHON AMIHUD (DPM)
Entity Type:Individual
Prefix:DR
First Name:GERSHON
Middle Name:AMIHUD
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8710 37TH AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7704
Mailing Address - Country:US
Mailing Address - Phone:718-457-7443
Mailing Address - Fax:718-457-6137
Practice Address - Street 1:8710 37TH AVE
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7704
Practice Address - Country:US
Practice Address - Phone:718-457-7443
Practice Address - Fax:718-457-6137
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0040951213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00971077Medicaid
NY00971077Medicaid
NY0815360001Medicare NSC
NYP17931Medicare ID - Type Unspecified