Provider Demographics
NPI:1619471323
Name:GOLDWASER, ERIC LURIA (DO, PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LURIA
Last Name:GOLDWASER
Suffix:
Gender:M
Credentials:DO, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 YORK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7917
Mailing Address - Country:US
Mailing Address - Phone:646-962-3199
Mailing Address - Fax:
Practice Address - Street 1:1165 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7917
Practice Address - Country:US
Practice Address - Phone:646-962-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316542-012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry