Provider Demographics
NPI:1609988211
Name:GOLDMAN, LAWRENCE S (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:S
Last Name:GOLDMAN
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 1:203 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1704
Mailing Address - Country:US
Mailing Address - Phone:631-585-5858
Mailing Address - Fax:631-585-6362
Practice Address - Street 1:203 UNION AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1704
Practice Address - Country:US
Practice Address - Phone:631-585-5858
Practice Address - Fax:631-585-6362
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164959-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2594571OtherGHI ID
NY433789NAOtherCIGNA ID
NY1935099OtherFIRST HEALTH ID
NY364487963OtherMAGNACARE ID
NY49975POtherHIP ID
NY01392332Medicaid
NY094AK1OtherBCBS ID
NY364487963OtherHORIZON ID
NY4C2934OtherHEALTHNET ID
NYAA50422BOtherMDNY ID
NY364487963OtherBEECH STREET ID
NY5193238OtherAMERI BEN CCN ID
NYP12037461OtherMULTIPLAN ID
NY84827OtherVYTRA ID
NYP1017054OtherOXFORD ID
NY1769226OtherUNITED HEALTH CARE ID
NY364487963OtherAMERICAN MEDICAL ID
NYGL4959OtherATLANTIS ID
NY5193238OtherAMERI BEN CCN ID
NY01392332Medicaid