Provider Demographics
NPI:1619008471
Name:GOLDMAN, DODI (PHD)
Entity Type:Individual
Prefix:
First Name:DODI
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 NASSAU DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2163
Mailing Address - Country:US
Mailing Address - Phone:516-487-6377
Mailing Address - Fax:
Practice Address - Street 1:235 W END AVE
Practice Address - Street 2:2E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3631
Practice Address - Country:US
Practice Address - Phone:212-787-0842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012234-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical