Provider Demographics
NPI:1831139856
Name:GOLDMAN, BARRY DAVID (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:DAVID
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 1:150 BROADWAY
Mailing Address - Street 2:SUITE #1110
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4357
Mailing Address - Country:US
Mailing Address - Phone:212-962-1115
Mailing Address - Fax:212-962-1246
Practice Address - Street 1:150 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4381
Practice Address - Country:US
Practice Address - Phone:212-962-1115
Practice Address - Fax:212-962-1246
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188106-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04D441Medicare PIN