Provider Demographics
NPI:1790896785
Name:GOLDMAN, GARY H (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:H
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 YORK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6855
Mailing Address - Country:US
Mailing Address - Phone:212-535-6100
Mailing Address - Fax:212-535-3956
Practice Address - Street 1:1735 YORK AVE STE A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6855
Practice Address - Country:US
Practice Address - Phone:212-535-6100
Practice Address - Fax:212-535-3956
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177375207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE44833Medicare UPIN