Provider Demographics
NPI:1780670745
Name:GOLDSMITH, JAY P (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:P
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E 60TH ST
Mailing Address - Street 2:SUITE7A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1117
Mailing Address - Country:US
Mailing Address - Phone:212-838-5895
Mailing Address - Fax:212-838-6007
Practice Address - Street 1:121 E 60TH ST
Practice Address - Street 2:SUITE7A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1117
Practice Address - Country:US
Practice Address - Phone:212-838-5895
Practice Address - Fax:212-838-6007
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264141223S0112X
NY0264141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY280319Medicaid
NY280319Medicaid
T50131Medicare UPIN