Provider Demographics
NPI:1821108861
Name:GOLDMAN, ADAM YURI (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:YURI
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 1:750 MCLEAN AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-3842
Mailing Address - Country:US
Mailing Address - Phone:914-803-0310
Mailing Address - Fax:914-803-0349
Practice Address - Street 1:750 MCLEAN AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-3842
Practice Address - Country:US
Practice Address - Phone:914-803-0310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193986174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01607390Medicaid
NY16545Medicare ID - Type Unspecified
NYG03777Medicare UPIN