Provider Demographics
NPI:1710766027
Name:GOLDSMITH, ARIELLA SHIRA (PA-C)
Entity Type:Individual
Prefix:
First Name:ARIELLA
Middle Name:SHIRA
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1310
Mailing Address - Country:US
Mailing Address - Phone:516-666-1724
Mailing Address - Fax:
Practice Address - Street 1:464 W BROADWAY
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1531
Practice Address - Country:US
Practice Address - Phone:516-569-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030598363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant