Provider Demographics
NPI:1851473011
Name:GOLDSMAN, CARY (MD)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:
Last Name:GOLDSMAN
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 1:652 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4361
Mailing Address - Country:US
Mailing Address - Phone:718-494-7546
Mailing Address - Fax:718-982-1613
Practice Address - Street 1:2344 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6607
Practice Address - Country:US
Practice Address - Phone:718-494-7546
Practice Address - Fax:718-982-1613
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157529174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01013767Medicaid
NY01013767Medicaid
NYA64783Medicare UPIN