Provider Demographics
NPI:1700863354
Name:GOLDSMITH, GERALD NORMAN (DPM)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:NORMAN
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MONMOUTH RD
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1029
Mailing Address - Country:US
Mailing Address - Phone:732-222-5666
Mailing Address - Fax:732-222-5684
Practice Address - Street 1:223 MONMOUTH RD
Practice Address - Street 2:SUITE 2D
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1029
Practice Address - Country:US
Practice Address - Phone:732-222-5666
Practice Address - Fax:732-222-5684
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00109800213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U26636Medicare UPIN