Provider Demographics
NPI:1811187586
Name:GOLDMAN, ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 ROUTE 202
Mailing Address - Street 2:SUITE 12
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2922
Mailing Address - Country:US
Mailing Address - Phone:845-354-2100
Mailing Address - Fax:845-354-2199
Practice Address - Street 1:1540 ROUTE 202
Practice Address - Street 2:SUITE 12
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2922
Practice Address - Country:US
Practice Address - Phone:845-354-2100
Practice Address - Fax:845-354-2199
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003553-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX003553-1OtherSTATE LICENSE
NYX003553-1OtherSTATE LICENSE