Provider Demographics
NPI:1619234705
Name:GOLDSCHMIDT, MATTHEW E (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:GOLDSCHMIDT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 MERRICK RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4642
Mailing Address - Country:US
Mailing Address - Phone:516-623-3940
Mailing Address - Fax:
Practice Address - Street 1:1955 MERRICK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4642
Practice Address - Country:US
Practice Address - Phone:516-623-3940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA40007563Medicare PIN