Provider Demographics
NPI:1588616874
Name:GOLDMAN, ALAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:B
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 PORT WASHINGTON BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576
Mailing Address - Country:US
Mailing Address - Phone:516-390-9640
Mailing Address - Fax:516-390-9650
Practice Address - Street 1:100 PORT WASHINGTON BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576
Practice Address - Country:US
Practice Address - Phone:516-390-9640
Practice Address - Fax:516-390-9650
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1935991207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01766090Medicaid
NY01766090Medicaid
G48204Medicare UPIN